06122 (ELEC)TAt�p
44
P.O. BOX 1504
No. 06122*
Building78-105 CALLE ESTADO 1
Address 54-629 Sotithern H1116 LAOUINTA, CALIFORNIA 92253
Owner'
4- T%— v. lc�_
"r. W__ - Qw U 44_"=30
Mailing
Address 42-600 Cook St., Sufte-200
City Zip Tel.,
. Palm Desert 1 92260- 1 M'd-28:
Contractor
Address
Zip Tel.:
State Lic. City
& Classif. '288-130, Lic. #
Arch., Engr.,
Designer
AddressTel.
BUILDING: TYPE CONST. OCC. GFIR,
i.
A.P. Number MlVest
Legal Description
Project Description
j28_, Sq. Ft. No.
Size.- .. - .. • . . Stories
_7
City p State 7. . Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 32 / of the Businessib6d Professions Code, and my license is in full force and
effect. " 1-7
SIGNATURE J A DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason:, (Sec. 7031.5,Businoss 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 rile a signed statement that he is licensed pursuant to
the provisions o/ 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 ($500). .
_JS] 1, as owner of the property, or my employees with as their sole compensation, will
''do -the work, and the structure is not intended or 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,
.,provfded Nat such improvements are. not. intended or offered for sale. If, however, the building
or improvement is 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 safe )
New 0 - , Add 0 .. Alter 0
No. Dw.
UniW
Repair 0 --Demolition 0- -
• O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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
S. M. 1.
such projects with a contractor(s) licensed -pursuant to the -Contractor's License Law.)
Estimated Valuation
IN
PERMIT
AMOUNT.
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Infrastructure
Mech.
Electrical
wo
• O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
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
S. M. 1.
such projects with a contractor(s) licensed -pursuant to the -Contractor's License Law.)
Grading
0 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.,
Date Owner
Infrastructure
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 certif%ddp,�!heireof. (Sec. 3800, Labor Code.)
Policy No. Companyf,.
0 Copy is filed with the city- ❑ii 6�rtifi441ci3p—Y is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM7,
WORKERS' COMPENSATION INSURANCE
REMARKS%
A�.
I 40o��— ftoex
(This section need not be completed if the perr�if is for one hundred dollars ($100) valuation
orless.)
I certify that in the performanceof thV 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- ff, after making this Certill
icate of Exemption you should become
-subject
ZONE:
BY:
to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances,
Front Setback .from Center Line
Rear Setback from. Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Centel Line
• 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.)
Side Setback from Property. Line i7
Lenders Nam -
.7—
Lenders Address
FINAL DATE
INSPECTOR
,This isA builclinpermit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have this
7/26/89
read application and.state that the above information is correct.
I -comply 'and
Issued by:
Date Pe rm it
agree to with all city county ordinances and state laws relating to building
A-
• construction; and hereby authorize representatives •of this • city to enter t -above-.
-fie
mentioned property for inspection purposes. -
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City,.State, Zip -7-
4
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
MOBILEHOME SVC.
BAR SINK
POR. SO. Ff. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO. Ff. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SO. FT.
LUMBER GR.
FINAL INSP.
URINAL
SO FT. ®
ROOFING
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
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 ® 11/4 c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR ® 3/ac
HOUSE SEWER
CERT. OCC.
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 GOND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING,
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL