06372 (SFD)ce
•4.4a
P.O. BOX 1504
Building 78-105 54-575 Shoal Creek LA QUINTACCALIFORNIA 92253
Address, , ,
_ ... _ 5uaria Cate MY
Address 7.5-00Comtry Club
City Zip Tel.
Palm Desert9225 508-2$2$,.,
Contractor
Address
ity lZip I Tel.
State Lic. 288130( City
& Classif. Lic. #
Arch., Engr.,
Designer
Address- Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000):of Division 3 of the Busines's and Professions Code, and my license is in full force and
•effect. � „�" .,_. ,i ,J ; < `
SIGNATURE - f' %0 if DATE
OWNER -BUILDER DECLARATION
I hereby affiryn that I am exempt from the Contractor's License Law for the following
reason:- (Sec. 7031.5,8rshess 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
requires the applicant for such pemd to Me a signed statement that he is licensed pursuant to
the provisions of the Contractors License law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Cade, 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
subjects the applicant to a civilpenally of not more than live hundred dollars ($500).
❑ I, 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 employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sok/ wdhin one year of completion, the owner -budder will have the burden
or proving that he did not build or Inprove for the purpose of sale.)
❑ I, 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 dads or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Ser R. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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 .Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
1 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: H, after making this Certificate of Exemption you should become
subject to the Workers' Conperrsadon provisions of the Labor Code, you must forthwith
comply with such provisions or this 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. (Sea 3097, Civil Code.)
Lender's Name
Lender's Address
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.
I certify that I 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 hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes
Signature of applicant ' Date'
Mailing Address
City, State, Zip'
No.
06372
BUILDING: TYPE CONST. OCC: GRP. _
A.P. Number PCIA West — chase 21A
Legal Description
Project Description A Tract 20717-3, Phase in
REMARKS hh r.is n��t dayrky+g4nY=�.t[r F;<a9, a9_�#c,7 v iA
J, 0 —. .•�e.1 ; r 2 ! V J �'jf_. I z Aril > i i
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 DATEINSP CTOR
9/20 89
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft. $ y
Size 1548
No. •
Stories
No. Dw_
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$168,545
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.71.�`,
Mech.
51. 00
Electrical
98..16
Plumbing
131,.,E
S. M.I.
7.63
Grading
Driveway Enc.
Infrastructure
$2.442.28
1,221.14
Less Credit
1.221.14
TOTAL
U1729.77
REMARKS hh r.is n��t dayrky+g4nY=�.t[r F;<a9, a9_�#c,7 v iA
J, 0 —. .•�e.1 ; r 2 ! V J �'jf_. I z Aril > i i
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 DATEINSP CTOR
9/20 89
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES '
1ST FL. SO. FT. ® $
UNITS
B GRADE lG
ROUGH PLUMB.BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
FORMS
F WER OR SEPTIC y
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
t/ AS (ROUGH) //
V
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. ®
=$
LUMBER GR.
AL INSPI�
URINAL
SQ. FT. @
ENTILATION
V 1 1Q
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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
FINISH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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
ND PLUMBING / 7
DERGROUND
A.C. UNIT
COLL, AREA
B GRADE lG
ROUGH PLUMB.BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
F WER OR SEPTIC y
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
UND. REINF. !
t/ AS (ROUGH) //
V
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
�REINF. STEEL
r
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
AL INSPI�
J
FRAMING —
FINAL INSP.
ENTILATION
V 1 1Q
olz
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
,y
A// THING 2 v
MESH
INSULATION/SOUND l2
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t