06421 (SFD)'
4
P.O. BOX 1504
Building 78-105 54-600 bowl Creek LA QUINTAC
Address rCALIFORNIA 92253
Sif=lse COMMMV
Address 42-600 St.. MID
CityZip Tel
Palm Desert 922609 1 568-2828,
Contractor
National Laud €t Xortgag$
Address
IZip I Tel.:
State Lic. I City
& Classif. 2881309 Lic. # 323 4
Arch., Engr.;
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license iso in full force and
effect.. { r V 7
.r' i'..•�..✓. si.. 1 .� a,t ,+ :�..ai'� r`tt.f r,:.:.cr
�SIGNAIURE r i -. 7 .X ti,r / DATE
r OWNER -BUILDER OECLARATION
I hereby affirm that I am exempt from the ContractoYs License Law for the following
reason: (Sec. 7031-5.Busiress and Professions Code: Any city or county .which requires a
Permit to eruct, after, 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 licensed pursuant ,to
the provisions of the Contractors License 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 exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a chillpenalty of not more than rive 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, Ouisness and
Professions Code: The Contractors 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 said within one year of completion, the owner -builder will have the burden
of proving OW he did not build or improve for the purpose of sale.)
❑ 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 properly who builds or improves thereon, and who contracts for
such projects with a contradorfs) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Wo
titer'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 furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed B the permit is for one hundred dollars ($100) vatuation
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 Califomm
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 provitions or Ibis 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, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I 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 hereby authorize representatives -of this 'city to 'enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date'
Mailing Address
City, State,- Zip
Z�_ Zf
No. 06421
BUILDING: TYPE CONST. OCC: GRP.. -
A.P. Number VGA Wo -at T+xtap 1AA
Legal Description
Project Description Tract 20717-3s Plan 31
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. 9,627
Size
No.
-Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ DemoliTion.❑
FINAL DATE
INSPECTOR
Issued by:
Date9126189 Permit
Validated by:
Validation:
Estimated Valuation
$113,727
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
S ' '563.0 1
Const.
68S . 5Q
Mech.
51013
Electrical
„I I. 1w
Plumbing
I`
S.M.I.
Grading
Driveway Enc.
Infrastructure
$2,558.86
1.279.43;
"A ('"dit
1.279.41
TOTAL
S2,822.09
r i+`4, : r F Ta e
REMARKS.
4A r is tis
�.�......2.�4�5,'tx '2
fil44bt.. 'd c:�hs.t•.">�`
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:
Date9126189 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
GRADE I� k ,
9UGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
FO MS F Y
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
I
EINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. @
GRADING
cu. yd.
$ plus x$
_$
ESTIMATED CONSTRUCTION VALUATION $
INAL INSP. - e
WATER PIPING
NOTE: Not to be used as property tax valuation
OOFING _
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
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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
SETB CK
ROUND NGjQA
UNDERGROUND
A.C. UNIT
COLL. AREA
GRADE I� k ,
9UGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FO MS F Y
ER OR SE IjjjZ"I K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
/ �
OTHER APPJEQUIP.
EINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
INAL INSP. - e
RAMING 1 — 3
FINAL INSP.
OOFING _
REMARKS.
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
//,,GGAR.
G THING — '-10,�0
MESH
�y
p /,Q)NSULATION/SOUND
P�"
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL