15741 (ADD)4
P.O. BOX 1504 No. 15741
Buildin
Address 43-21.0 Paso Tiemp0 LA 78'495 CALLE O
QUINTA, CALIFORNIARNIA 92253
Owner
T.D. Desert Development
Mailing BUILDING: -TYPE CONST. Vn OCC: GRP.
Address 38145 Crocus Lia.
A.P. Number 7
CitvPalm Desert zip 92211 Tel. 777-779.3Lot 33
Legal Description
Contractor sparks Construction Project Description 132 sf addition to family room
'
Address
P.O. Box 1736
City Zip Tela
La Qul.nta 92253 773--1941
State Lic. City
& Classif. 674074 Lic. # 2996 Sq. Ft. 112 No. No. Dw.
Arch., Engr., Size Stories Units
Designer V&V Architecture New ❑ Add= Alter ❑ Repair ❑ Demolition ❑
Address Tel.
38145 Crocus a.e 773--5393
citvPaim Desert -
ZIP 92233 State Lic. Lic. # y
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm than a licensed unde pr ro ions of Chapter 9 (commencing with Section
7000)'of Drv'si n of the Business°and Profession Code, and my license is in full force and
effect. ,
GNAT I `t? 11— •V Y.`ia'Y ! d` 5. : t.+••: P DATE
1-4
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following °$ t !+s
29 ��
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also I
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of ��
D(vislon 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis - -
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). �.„V
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. a
20
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner or property who Const. $.j-3$ a 00
builds or improves thereon and who does such work himself or through his own employees, Mech. ��"
provided that such Improvements are not intended or offered for sale. If, however, the building c
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or bnprove for the purpose of sale.) Electrical 19.92
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing $ 38.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law p�
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. - .87
such projects with a contractor(s) #caned pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polyp i No. Company
fO Copy is filed with the city, O Certified copy is hereby furnished.
TOTAL $230.!;9,
CERTIFICATE OF EXEMPTION FROM REMARKS
•
WORKERS' COMPEPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
' or less.) ,
I certify that in the performance of thg work for which this permit is issued, I shall not -
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO 'APPLICANT. If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith -
complywith such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center L "
Rear Setback from Rear in
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback nter Lin
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, . Side Setback.fro P opert Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES. /
r/
This is a building FINAL DATE PECT
permit when properly filled out, signed andvalidated, and is to •
expiration it work thereunder is suspended for 180 days. "
I certify that l have read this application and state that the above information is correct. Issued by: Date Pe'�Ttit
I agree to comply with all city and county ordinances and state laws relating to building n
construction, and hereby authorize representatives -,Of this city to enter the above-. t7'
mentioned property for inspection purposes:
Validated by:
Signature of applicant Date
Mailing Address Validation:. f
City, State, Zip /
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
.2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ' ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER - -
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCG
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL