05043 (SFD)tc-*'
.Ak-Tiht44Q-
P.O. BOX 1504 No. 05043
Building 54-647 Shoal Cud'@R LAOUINTACCA_LFORNIA92253
Address
Owner
Suurfse Cpmpauy BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address StreQ,tt � gti e2aa A.P. Number DQ3A in7lant ��t��r� 104
City F ip Tel " ' '
Palm Deaert 92260 54A_2,R2R Legal Description
Contractor Project Description 21 --n
it,
Address
City `• Zip Tela
State Lic. City
& Classif. 288130. Lic. # 328 Sq. Ft. 1918 No. No. Dw.
Arch., Engr., Size Stories Units—
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
CityZip State
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 Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,eusiness and Professions Code: Any city or county which regr®es a
Permit to construct, after, Improve, demolish, or repair any structure, prior to 8s issuance afro
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therehum, and the basis
for the alleged exemption. Any violation of Section 703.1.5 by 'any applicant mor a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (5500).
❑ 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, Buftness and
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or improves thereon and who does such work himself or through his own errpbyees,
provided that such improvements are not intended or offered for safe. if, however, the budcriV
or improvement is sold within one year of completion, the owner -builder wig have the burden
of proving that he did not burrld or improve 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 appy to an owner of property who builds or f nproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec • B. & P.C. for this reason
Date Owner
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 Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dofhars (5700) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 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: 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.
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.)
Lenders Name
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days.
I certity 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
stimated valuation
$132,816
BY:
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk- Bal
8 442.73
Const.
515.50
Mech.
34.00
Electrical
74.69
Plumbing
87.50
S.M.I.
9.28
Grading
Driveway Enc.
Validation:
Infrastructure $2.988.36
1.494.18
TOTAL $2.657.88
'S r c' +• % £
REMARKS '
A-15 i'rfg-PS x0;"irx s e f � x: tit'•'t3 �-- rite 10-
.r
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
12/23/88
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO FT ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND -FC. SQ. FT. @
FORMS
ER OR SEMIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TE . POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. ®
=$
L MBER GR.
FINAL INSP.
RAMING
URINAL
SQ. FT. @
t , /�
2 q�
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
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(AUTOXDISH)
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.
SO. FT. ® c
BATH TUB
FIN SH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 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
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SEMIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
4AS (FINAL)
TE . POLE
GROUT
WATER HEATER
WA -
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd.
$ plus x$
=$
L MBER GR.
FINAL INSP.
RAMING
FINAL INSP.
ROOFING
t , /�
2 q�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
SH
SULATIONISOUND
FIN SH GRADING
,�-,•
AL INSPECTION "1
LLL
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
1