15671 (SFD)T &-t 4 4 Q*M
Building
Address 79-p180 Ladera Dr.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
Snel,lenberger & Associates
mailin
Address 41--865 Boardwalk, Ste. 212
City Zip Tel.
Palm Desert, ±% 92211 1(619)777-7768.
Contractor
Sam
City lZip
State Lic. City
& Classif. $ 4$82.34 Lic. # 1855
Arch., Engr., Charles D. GarlandDesigner
Ad "$.L63 Cathe-drat Cyn Dr. TT,519 } 770"7{325
ClSta
Cathedral 4rit. �� CA 9223 Lic.t#
LICENSED CONTRACTOR'S DECLARATION
I herebyyaffirm that I arri licen under provisions of Chapter 9 (commencing with Section
7000) of,,Divisio 3 of the.Busjn atid;P;irofessions ode, and my license is.i fuIll or -and
effect. ��-"��w•`..��" •'";,�A'" "°^
GNA-URE' 4p -,r DATE
OWNER-BUi•LDER DECLARATION
(realsoin:
/reby affirm that I am exempt from the Contractor's License Law for the following
(Sec. 7031.5,Business and Professions Code: Any city or county which requires a
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 exemptbn. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penally or not more than rive 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 Lew 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 bulkd or improve for the purpose of sale.)
0A, 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) [censed 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 conbs qt to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company 4V
❑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 it the permit is. for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any parson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT, N, 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.
~� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES "UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,0)0), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
Thls is a building permit when properly filled out, signed and validated, and is subject to
Al 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
No. 15671
LDING: TYPE CONST. VN OCC. GRP. R"'3
Number 604-272-006
Legal Description Lot 100 Tract 23913
Project Description SFS Plan 2 model
QD:1 Marr a
Sq. Ft. No.
Size 2132 Stories
New ❑ Add ❑ ' Alter ❑
Aimated Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing.
S.M.I.
Grading
Driveway Enc.
Infrastructure
Arts in. Pu.
No. Dw.
Repair ❑ Demolition ❑
250.00
AMOUNT .
. 360.71
741.00
55.50
150.06
150.00
12.86
20.00
.00
2#868,05
71.40
TOTAL f 1 4#687.58 1 4,437.53
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear(Prop'SLine
Side Street Setback from//Center yLine
Side Setback from PrropAy Line^\
FINAL DATE
INSPECT(
!
�t
Issued by:
-
Date 4 -
Validated by: t\
Validated
-Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
I ROOF DRAINS
CAR P. SO. FT.
ROUGH WIRING
DRAINAGE PIPING
WALL SO. FT.
FOUND. REINF.
DRINKING FOUNTAIN.
SO. FT. ®
ETER LOOP
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
BOND BEAM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
.FINAL INSP
LAUNDRYTRAY
AIR HANDLING UNIT CFM
LUMBER GR.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR p 3/4c
HOUSE SEWER
GAR. FIREWALL
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
41 0
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH 'PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEW Cgf�
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
ETER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEAT
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
.FINAL INSP
RADING
cu. yd.
$ plus , x$
=$
LUMBER GR.
FRAMING rib
ROOFING
VENTILATION
j�Ji1 r
''�U
i -�' • / .
�✓ ��
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
.1
SPARK ARRESTOR
GAR. FIREWALL
LATHINGpfO�
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL