12701 (SFD)tyl
4
P.O. BOX 1504 N o . 12701
Building78-105 CALLS ESTADO
Address 79-595 Star Flower Trail LA QUINTA, CALIFORNIA 92253
Owner
Roger Sn llenberger a Associates
,Address 55_695 Pebble Beech
City- Zip . Tel.
%a Quinta. C's 1 92253 1619)777-7767
Contractor•
--- <
Address
Zip
State Lia City
& Classif. B 488234 Lc. # J$58
Arcn., tngr.,
Designer Arles Elias — Engineer
Address Tel.
38825 Charlesworth Dr. 1619)328-72,71_
Cit Zip State
Cathedral City 92234 Lic. #
LICENSED CONTRACTOR'S DECLARATION:
) hereby affirm that Ilam licensed under provisions of Chapter 9 (commencing with Section
x000) of Division 3 of the Business and Professions Code, and my'license is in full force and
effect. L/ t� 4
SIGNATURE 'x.•' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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 file 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 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 civil penalty of not more than five hundred dollars (8500).
O 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 1s sold within one year of completion, the owner -builder will 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.) '
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner J
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 IN Company
Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
'WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) 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: 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.)
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 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 604-253-004
Legal Description Lot 65 Tract 24209
Project Description SOD Plan 3
Sq. Ft. 1$® No. No. Dw.
Size Stories Units
New ❑ !Add ❑ Alter ❑ Repair ❑ Demolition ❑
stlmated Valuation
�'��•
PERMIT
AMOUNT
Plan Chk. Dep.
25fj •
Plan Chk. Bal.
J1 d •
Const.
• ��
Mech.
55. 5U'
Electrical
140 . f3
iPlumbing
s44 . 0 U
t.S.M.I.
l U . '1 4
Grading
ZU.
Driveway Enc.
. UU
Infrastructure
2 r 416.5 1 7
;Otis .1.11 publI
s: Places
25. 1010
TOTAL
4t BYfL•Gtf.
J01S,c0 AU
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Sireet Setback from Center Line -
Side Setback from Property Line
FINAL DA
Issued by
Validated
Validatior
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
SEWER 0 K
ROUGH WIRING
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. @
GROUT
WATER HEATE
DRAINAGE PIPING
CAR P. SQ. FT. @
BOND BEAM
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
_$
LUMBER GR.
URINAL
SQ FT ®
V If \
r
{
v
�J (fn
I l
V
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:b
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
LATHING W A 3`
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
M=CH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACKAl-7
z QfI GROUND PLUMBING aUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE A9
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER 0 K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. ! ` (
GAS (ROUGH)2•YfTEM
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
P. POLE
GROUT
WATER HEATE
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
n
FRAMING '� 2 7
!!! l A
U
ROOFIN 3 y !
V If \
r
{
v
�J (fn
I l
V
REMARKS:b
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING W A 3`
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUR WINITrAUS
GARDEN WALL FINAL