14168 (SFD)P.O. BOX 1504 No. 14168
Building 78-105 CALLE ESTADO
Address 79-705 iris Court LA QUINTA, CALIFORNIA 92253
O— 'Roger 6ael-1 enberger & Aascciates
mailin
Address
City Zip Tel.
1 (
Contractor
Same
Address
Zip I Tel.
State Lic. City
& Classif. B 488234 Lic. # 1858
Arch.Desi nergr
9 Carlos Elias Engineer:
Ad J s42$: Charlesworth Dr. Telt619j 328-727
City Zip State
Ca�;edral Ci y, CA 9223 iC. #
LICENSED CONTRACTOR'S DECLARATION
,7I hereby affirm that I am,licensed-under provisions of Chapter 9 (commencing with Section
/A00) of Division 3 of,the Business and Professions Code, and my license is in full force a d
!!!effect. / i 1 % t 4 —e v. rc
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, alter, 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 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 ($500).
❑ 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 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 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 property who builds or improves thereon, and who contracts for
- such projects with a contractors) 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 Nod Company
1340py is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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 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
Ihereby 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 when hen 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
JILDING: TYPE CONST. V14 OCC. GRP.
P. Number 604-253-010
Description Lot 10 Tract 24208
R3
Project Description $FD' Plan o6
Cactus Flower Ii
ZONE:
BY:
Minimum Setback
Distances:
Sq. Ft. 1,684
Size
No..
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Side Street Setback fro L' e
Side Setback from Pry Line Q
FINAL DATE
INSPECT01.0
Issued by:
Date ty Permi't' 7a
Validated by:
Estimated Valuation
WJEijz.,b1
.0
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
g'p
Const.
m3 U• UP
Mech.
62 .. V u
Electrical
1 33 • U4
Plumbing
xfli . UV
.S.M.l.
1U 40
Grading
do. ou
Driveway Enc.
UO
Infrastructure
'
r.
Y'' 4 JI..Y LLw 3.
,C .t4.iii.�3YS
S+3,061
TOTALS
•
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center.Line
Rear Setback from Rear/'ro . Lin
enter
Side Street Setback fro L' e
Side Setback from Pry Line Q
FINAL DATE
INSPECT01.0
Issued by:
Date ty Permi't' 7a
Validated by:
Validation:
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
r „
ROUGH PLUMB.
YARD SPKLR SYSTEM
�
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH
DRAINAGE PIPING
CAR P. I SQ. FT.
HEATING (FINAL)
OTHER APPJEQUIP.
WALL SO. FT.
GAS (FINAL)
DRINKING FOUNTAIN.
SQ FT ®
URINAL
"ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax.valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT. SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP. '21 V's 6
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROOFING �
VENTILATION
LAUNDRY.TRAY
AIR HANDLING UNIT CFM
/
/ �j �i�
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
..Rall
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
'FORMS
SEWER O
9OUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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. '21 V's 6
FRAMING
FINAL INSP.
If
ROOFING �
VENTILATION
Q J/ l_y/� _ w �.
„ �J
/
/ �j �i�
REMARKS:
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LAT
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
INSULATION CERTIFICATioN
This is to cerenergy
rey that insulation has bcen installed 11Y
current energy regulatsan, California Adminlstretive Codec Txtl� a with the
California, in the build-' located at:
4 Slate of
SI?E ADDRESS
CEILINGs
Batts: Type -ERMLA—S Manufacturer Thickutess �i� R -Value R-38
Blown:
Type Manufacturer
UOR WALLS Thickness _' R -Value
7Ype JUSOMV Manufacturer t
R=RS iM1Thickness _358 Ig•V81ue i 3
____ V3��Gttirer -..�_ i
�Thiclosess �4 R -Value
.Gencral COAtractor
License #BY
Title Date
Scald insulation Contractors, Yncs
License ; 221517 C-2
Title Vice President s
Date
INSUt.ATION MrrTFICATION
•
This is to certify that ims�alatias� W been
alrrent energy � Euzaticm California
installed in cOnfO with the
California � Adn'nistrative
ire the building located at:
Cade, Title 2� State of
SITE M74ESS
CFI- LI GS
CA
Batts: 1y►ge —EAR i acturer
/
Blown: TypeMm-
�-� Th.icimess
12"
.�.:_ �-Value R�38
ufacturer
-EXMIOR WALLS
Thicknesses
R -Value
Type —p—n—w—amm �ftnu.facturer ON&CWCORN=
R=S MaZnufacturer
`----
Thickness
3518
�� R -Value R-13
General Contractor
Thi -cess
R -Value
License f
BY
Title
Title
nate
Schmid Insulation Cont Inc.
BY
License '#
2,1517 C-2
TitleVECP
" ont Date
i2--27-94