06417 (SFD)Building
Address 54-744 Shoal Creek
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Mailing
Address &2-600 Q
Mk
City Zip
Palm Desert I
92260
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P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
ttatlo=l Laad & tW rt ge
Address
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City lZip
State Lic. I City
& Classif. 28813D Lic. # 328
Arch., Engr.,
Designer
Address Tel.
CityI Zip I 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: j .0 .,.....--•- A,
SIGNATURE DATE
f' OWNER -BUILDER DECLARATION '
I hereby affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usirmess 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 permit to We a signed statement that he is licensed pursuant to
the provisions of the Conhactors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Busemess and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by any applicant for a permit
subjects the applicant to a civilpenalty of not more than two hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, andthe structure is not intended or offered for sale. (Sec. 7044, 0uisness and
Professions Code: The Contactors License Law does not apply to an owner of property who
builds 'or knproves thereon and who does such work himself or through his own employees,
Provided that such krprovements are not intended or offered for sale. If, however, the building
or improvement is sold withki one year of completion, the owner -builder wig have the burden
of proving that he did not build 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 apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sea a, & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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 furnished.
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.)
I 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 California
Date Owner
NOTICE TO APPLICANT: fl, after making this Certificate of Exemption you should become
subject to the workers' Compensation provwtons 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, CW Code.)
Lender's Name-
Lender's
ame
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 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
1-- q
No. 06417
BUILDING: TYPE CONST. OCC: GRP.
A. P.. Number 'PCA 'West — Fhase 18A
Legal Description
Project Description
'Tract 20717-3, Phase 3MR
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. 11527
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
f
Issued
Issued by:
Date Permit
Validated by:
Validation:
Estimated Valuation
$113,727
PERMIT
AMOUNT
Plan Chk. Dep:'
Plan Chk. Bal.
�? , , 9fj3•$3ft
Const.
088.50
Mech.
.5 .
Electrical
. Z.
Plumbing
131.00 \-
S.M.I.
.9$
Grading
Driveway Enc.
Infrastructure
Les» Credit
1,279-43
TOTAL
REMARKS
s,i.s:
fi3t4tft`� ..i rl
t',i.._
_ -;.2 • .,._
V L lir',.. A e: Q 4t:. w yt '!
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
f
Issued
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES,
1ST FL. SQ. FT. ® $
UNITS
R GH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. Ff. @
DUCT WORK
ROCK STORAGE
REINF.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
/PrEINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SQ. Fr. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CAR P. SQ. Fr. ®
LUMBER GR.
F NAL INS
F ING �� —
FINAL INSP.
DRINKING FOUNTAIN
WALL SQ FT ®
REMARKS:
URINAL
SD. FT. @
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
LAUNDRYTRAY
AIR HANDLING UNIT CFM
MESH
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
CERT. OCC.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
INSPECTOR'S StGNATURESIINITIALS
SQ.FT.GAR @ 3/ic
HOUSE SEWER
GARDEN WALL FINAL
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'v UNDERGROUND
A.C. UNIT
COLL. AREA
,/ RADE l '9
R GH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SE K ROUGH WIRING
DUCT WORK
ROCK STORAGE
REINF.
�qAAS(ROUGH) /-Z2 METER LOOP
O
HEATING (FINAL)
OTHER APPJEQUIP.
/PrEINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. cu. yd.
$ plus x$
-$
LUMBER GR.
F NAL INS
F ING �� —
FINAL INSP.
S41G C C
q/
tot,, `
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
r
THING l —lo—se.;
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S StGNATURESIINITIALS
GARDEN WALL FINAL