04355Buildin
Address
9 Tanglewood
Minrise Compa
Mailing.
Address
" I . 75-005 County
City, Zip
i4v-Desert 92260
Contractor
National Morteaq
P.O.-BOX 1504
78-105 CALLE ESTADO
LA PILIINTA-CALIFORNIA 92253-",
BUILDING:, TYPE CONST. OCC. GRP.
DriVV4 A.P. Number Ma West The Grc6ns
Legal Description
Project Description Plan AdR - Pha$6 76
City--., %Zi
Tel.
State L'
Ic
& Classif.
City
3 9 9
Lic. III•
�Sq_ Ft.,
No., No. Dw.
Size
Stories Units
Arch., Engr.
-"Designer
New 0 Add 0
Alter 0 Repair 0 Demolition 0
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1am licensed under provisions of Chapter 9 (commencing with Section
,
7000) of Division 3 of he Business and Professions Code, and my licenseis in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
3,,reaion:;(Sec. 7031.5.Business and Professions Code: Any city or county which requires a
Estimated Valuation -
PERMIT
AMOUNT
permit to , construct, alter, Improve, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit to.file a signed statement that he is licensed pursuant to
it,e provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that.heis exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
0 1, as owner of the property, or my employees with wages as their sole compensation, will
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 of property who
builds or, improves thereon and who does such work himself or through his own employ
not intended or offered for sale. If, however, ees.
provided t . the building
• lhat such Improvements are -not
.,or. improvement is sold within one year of corripletion, the owner -builder will have the burden
of proving that he did not build of improve for the purpose of sale.)
0 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plan Chk. Dep.,
Plan Chk. Bal.
Const.
Mech.
i
Electrical
Plumbing
struct the project. (Sec: 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
S. M. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Eric.
Date -owner
-
I nf rastruct , ure.xi
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-insure.'or a certificate of
not Iii trastrudare .
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. company
Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(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 thp work for which this permit is issued, I shall not
TOTAL
REMARKS
j -1 a* 07
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
subject: to.the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear,Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY a
Side Street Setback from Center Line",
I hereby affirm that there is a construction lending agency'for the Performance of the
work for which this permit is issued. (Seca 3097, Civil_Code.)
Side Setback from Property Line.
Lender's, Name
Lender's Address
This is a building permit when properly filled out, signed and validated; and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above Information is correct.
agree.to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives .,of this city to enter the above-
mentioned property for inspection purposes.
FINAL DATE -
Issued by:
Validated by:
INSP.
Date Permit
Signature of appllca4 -Date
Mailing Address
Validation: A
-GOLDENROD -ASSESSOR'S OFFICE; COPY- FILE
0
City, State,, Zip
41
-1 FINA
�!HITE P
!jlPE;,fII1lK �A PL ICA NT,I,GR EEN 6 U11LDING'_.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT h $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. tr
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTCr
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OUTLET
ROOF DRAINS
GAR SO. FT. 0POWER
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. Q
=$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. td
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOYDISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM .
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 1% c
SEWAGE DISPOSAL
SO.FT.GAR rg Tr c
HOUSE SEWER
I
CERT. OCC.
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 8 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 APPJEOUIP.
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
I ION
I
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINiT1Al5
GARDEN WALL FINAL
-'„