07679 (SATT)C&hf44a
P.O. BOX 1504
No. 07679
Buildin78-105Addrress 55-4.512 Laurel Valley LA QUINTACCALIFORNIA 92253
Owner % kv, a— t
Sri BUILDING: TYPE CONST.
Mailing _OCC, GRP.
GRP.
Address 42-600 Cook St. Shite 200 A.P. Number PGA West
City Zip Tel.
Palm Desert 92260 56$-2828, Legal Description Tract 25500-1
Contractor Phase 2* Plan IU
Project Description
t ona1 Land A Mortgage
Address
Sam
City Zip Tel.'
•_State Lic.City
& Classif. 2 130� Lic. # 328 Sq. Ft. tm No. No. Dw.
Arch., Engr., Size • Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
A/ LICENSED CONTRACTOR'S DECLARATION
' 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
X7000) of Division 3 of the Business and Professions Code,. and my license is in full force and
effect w"'` r- -"-
def` j /`! w! tsi5 .. a ..
SIGNAdURE '' ' " � -✓"' '" JE o ✓ UA'�TE
f ` OWNER -BUILDER DECLARATION r
I hereby affirmkthat I am exempt from the'Contractor's License Law for the following Estimated Valuation
•reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 1
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT -
n the provisions of the Contractor's License Law, Chapter 9°(commencing with Section 7000) of
Division 3 o/ the Business and Professions Code, or thathe is exempt therefrom, and the basis
4 for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant /or a permit Plan Chk. Dep.
,subjects the applicant to a civil penalty of not more than live hundred dollars .($500).��
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. r
83
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 626
Professions Code: The Contractor's License Law does not apply to an owner of property who r
00
builds or improves thereon and who does such work himself or through his own employees, Mech. 60.60
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 pY
of proving that he did not build or improve for the purpose o/ sale.) Electrical 8o4'w
'•'+d
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 120,50
• 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.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
❑ I .em exempt under Sec. Grading B. 8 P.C. for this reason ,
Driveway Enc.
Date owner Infrastructure 2,161.15 19.58
ss Cftd#t 11080.58
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. O Certified copy is hereby furnished.
TOTAL -7.14448
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation
or q{#3�''x XiAil'1-, ;
or less.) ,.v e.+.7c:..,. •a , e...,u. .� �•
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. It, after making . this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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./r `�
I certify that I have read this application and state that the above information is correct. Issued by: Date ermlt
I agree to comply with all city and county ordinances and state laws relating to building 7(
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date -
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT, ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
ROCK STORAGE
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
SO FT ®
OTHER APPJEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
SO.FT.GAR ® Vic
HOUSE SEWER
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
_
i
OUND PLUMBING tlJ
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SEWER OR�EPi1�.vJ
ROUGH WIRING.
DUCTWORK
ROCK STORAGE
FOUND. REINF. S�a� \
V
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.
/y
(41<FRAMING
FINAL INSP.
WW 1�—��
ROOFING
12i_1 nL�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
FIREWALL
'//GAR.
�GC_LATHING U
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL