06748 (BLCK)P.O. BOX 1504 No. 0674$
Building 78-105 CALLE ESTADO
Address 54-4W Shoal Creek = - LA QUINTA, CALIFORNIA 92253
Owner v
Mailing'
:ulnrUe@isOi'pany BUILDING: TYPE CONST. OCC: GRP.
Address 42-00 Ctx3k Strftat. ISR; iiitp 2noT A.P. Number PGA West` Phase 21A
City Zip Tel.
Palm Desert $2254 568-2$2$ _ , Legal. Description
Contractor Project Description
41-6 L.P. of 6' Mock wall
S�
Address cOu=u 8Yt& TM
City Zip Tel.:
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Q000) of Division 3,oif the Business and Professions Code, and, license license is in full force and
ffecL
SIGNATURE c y,� .+'.... d''M-.+1,,.- 3"e_i.-. r DATE .
OWNER -BUILDER DECLARATION Estimated Valuation t
I hereby affign that I am exempt from the Contractor's License Law for the following 1®
reason: (Sea 7031.5,�X7
ss and Professions Code: Any city, or county which requires a f
Permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Me a signed statement that he is fx:ensed pursuant to PERMIT AMOUNT
the provisions of the Contractors License taw, Chapter 9 (commencing with Section 7000) of
Oivisiwr 3 of the bless 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 appiwrt to a chig penally of not more than five hundred dollars (E50Q.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 9qt !�
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and4t3
Professions Code. The Contractor16Vs License Law does not apply to an owner of property who COr1St.
builds or improves 0reeorn and who does such work himself or through his own employees, Mech.
provided that such irprovememts are not intended or offered for sale. If, however, the building
or fnprovement is sop wmbrin one year of completion, the owner -budder wig have the burden Electrical
of proving that he did not bull or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law 7
does not apply to an owner of property who builds or improves thereon, ane who contracts for S.M.I. • f'!
such projects wim a oris) lcensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec B. & 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.)
Policy No Com PY,, r.
❑ Copy is filed with the city. 'Ll'Certified copy is hereby fumished.
TOTAL
CERTIWO KR ERSCATE OF COMPENSATION INSURANCEPTION FROM R?� ,, �•, {f}
15 ^st_ t Flii .-ircdl ..:15;
(This section need not be completed if the permit is for one hundred dollars ($100) valuation x v -- -x.: �.•: - h. - v+-. v x::. <. �. _ .
or less.)
1 certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of Cali omia
Date Owner
NOTICE TO APPLICANT. 9, after making this Certificate of Exemption you should become ZONE: BY:
subject to the "bikers' Conpersation provisions of the Labor Code, you must forthwith
comply with scan provk*= or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Cfvg Code.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INSPECTOR
This is a'building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. �g I�� ?
I certify that 1 have read this application and state that the above information is correct. Issued by: 1 Date 2 t$ Permit
I 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. Validated by:
Signature of applicant Date'
Mailing Address Validation:
City„ State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR_ SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SQ. FT. ®
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ. FT. @
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR @ 34c
HOUSE SEWER
07
NAL INSPECTIO :i�
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
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
07
NAL INSPECTIO :i�
CERT. OCC,
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL