07696 (SATT)•414
4"..
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO -
Address 65-04 Laurel Val ley LA QUINTA, CALIFORNIA 92253
Owner
Sf tnr9 $E G+ any
Mailing
Address —fitQ Cank , su
City
. Zip Tel.
Palm Desert 92268 568.2823
Contractor
National Land 6 Mortgage
Address
Sam
City Zip Tel.:
'State Lic. City
.& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
City p
Zi State
j
Lic. #
� LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) 91, ivislon 3 of the Business and Professions Code, and my license is in full force and
effects t •t%-.. .? r3... !:?i�r r°t
I/` i 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 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 (5500).
. 0 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 improvesthereon 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.)
❑ 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 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. 0 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
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 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
ateMailing Address
City, State, Zip
07696
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PGA Moot
Legal Description Tract 25500-1
Project Description Phase 2H Pian 3UdR
Sq. Ft.,No. No. Dw.
Size ' sin Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
V
Plan Chk. Dep.
Plan Chk. Bal.
Const.
832,00
Mech.
Electrical
Plumbing
INSPECTOR
S.M.I.
Date 4/2 MK Permit
Grading
Driveway Enc.
Validation:
Infrastructure
4 AID
TOTAL C:�
REMARKS
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
Issued by:
Date 4/2 MK Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
OUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM . • FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
(ROUGH) ¢
a
LAUNDRY TRAY .
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
/RAMING
FINAL INSP.
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
ROUND PLUMBIN f �.Qd
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
J11JAAS
EWER OR SEPTI f/�
[� "�
ROGH WIRING.
DUCT WORK
ROCK STORAGE
�OUND. REINF.
(ROUGH) ¢
a
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/v. _
/RAMING
FINAL INSP.
KROOFING
AJ
ice
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
RIKA THING
/ gMESH
/ �/ INSULATION/SOUND
w \
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL •
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
- c, r- '.