06026 (RC)Building
Address
Chat Dort!
Mailing
Address 73242 Joshua Tree
City Palm Desert I
Zip 92260
Contractor
Roger1. Jobus a
Address
P.O. Bax 1648
City Zip
Palra Desert 92261
State Lic-
& Classif- 341036
Arch., Engr.,
Designer
Address
4
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel- 3407
H
Tela
56572208
City
Lic. #
Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOWS DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. _.—.1'S ." Y` al*— `t
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
°.: reason (Sec. 7031-5,8usihess and Professions Code: Any city or county which requires a
pemmd to construc, atter, irprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to tie a signed statement that he is licensed pursuant to
the provisions of the Contractors LIcermse Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exeap0an. Any violation of SeUlon 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally of not more than live hundred dollars ($500).
❑ 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
Polessitim Code: The Conbactors License Law does not apply to an owner of property who
budts or= thereon and who does such work himself or through his own employees,
provided tlmat" sutYh brprovemerhts are not Wended or offeredfor sale. It however, the building
orrnpvovanent is sold within one year or conpfetion, the owner -builder will have the burden
of prorig that he did not build or improve for the purpose of safe.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con.
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 reproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. a_ & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation • Insurance, or a certified copy,:thereof. (Sec. 3800, Labor Code.)
Policy Nom ° f f l "_.company T1_ r•'7i"'"'
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKED' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.)
certify that in the performance of thF work for which this permit is issued, I shall not
employ any person in arty manner so as to become subject to the Workers' Compensation
Laws of California
Date owner
NOTICE TO APPLICANT: 8, after malting this Certilkate of Exemption you should become
subject to the Workers' Corrpensation provisions of the Labor Code, you must forthwith
co pry with such provisions or tins permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued- (Sec. 3097, Chd Code.)
Lenders Name
Lender's Address
This is a building permiwhen hen properly filled out signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that 1 have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and thereby authorize representatives -of this city to enter the -above,
mentioned property for inspection purposes-
Signature
urposesSignature of applicant Date
Mailing Address
City, State, Zip
No. 06026
UILDING: TYPE CONST. OCC. GRP.
P. Number 773-07$-028
,-gal Description Lot's 1-4 SCS VW #14
roject Description Pt?no'b'ate exterlor of
Hardware Store
ZONE: BY:
Minimum Setback Distances:
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: —Date 6-22-89 Permit
Validated by:
Validation:
^Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add O Alter ®
Repair ❑
'Demolition ❑
�JSY
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const-
Mech.
Electrical
Plumbing
S.M.I.
.%
Grading
Driveway Enc.
Infrastructure
h
TOTAL
REMARKS..-,c..tsr-t�
1`0
....
ZONE: BY:
Minimum Setback Distances:
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: —Date 6-22-89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SD. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
DRAINS
GAR. SO. FT. ®
HEATING (FINAL)
IROOF
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL Sp. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SD. FT. @
GRADING
cu. yd.
-Plus-x$-=$
I
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ V4c
HOUSE SEWER
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 APPJEQUIP.
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 1
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1