10555 (RPL)P.O. BOX 1504
Building 78.105 CALLE ESTADO
Address 45•-450 Desert Eagle Ct LA QUINTA, CALIFORNIA 92253
owner
Santa Rosa Developers. Inc.
Melling
Address 45-275 Desert Cagle Ct
City !Ip Tei.
La Qui.nta . 92.253 345-1216
contractor
Steve Dodson Construction
Addregsb-,,, A Perez lid 09.
City Cat City' 'lp92234 Tel 'a24-1232
State Lic. City
& Classif. 574127 A Lic. # �.Q44
Arcn., tngr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I em licensed under provlslons of Chapter B (commencing with Section
7090) of Divlelon 3 of the Business and pro one Code, and my license Is In full force and
^ Xect. X:
CrSIGNATURE DATE
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.8,Buslness.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 Ills a signed statement that. he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter a (commencing with Section. 7000) of
'Divislon 3 of the Business and Professions Code, or that. he It 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 then five hundred dollers.($500).
❑ 1 as owner of the property, or my employees withwages as. their sole compensation, will
do the work, and the structure Is not Intended or offered for sale. (Sec. 7044, Bulsness 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•bullder will have the burden '
of proving that he did not build or Improve for the purpose of eale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
9truct 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. S. & 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'e.Compensatlon Insurance, or a certified copy thereof. (Sec. 3800,.Labor Code.)
Policy No. 'Company
417 Copy Is filed with the city. ❑ Certified copy 18 hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit la for one hundred .dollars (5100) valuation
Or 1088.)
I certify that In. the performance of thg work for which this permit Is Issued, I shall not '
employ any pperson In any manner so as to become'subject to the Workers' Compensation
Laws of Callfornla.
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
Lenders Address
This Is a building permit 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 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 appllcant -Date,
Melling Address
City, State, 21p
BUILDING: TYPE CONST._
No. 1 5 t)��
_OCC: GRP.
A.P. Number
Legal Description
Project Description
P00,11, AND
SPA
4
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ -Demolition ❑
Estimated Valuation
12_000
•PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
97.75
Const.
1 S
Mach.
Electrical
Plumbing
@ f10
S.M.I.
. 7 )A
uraoing r -
Driveway Enc. 1 ''
Infrastructure
TOTAL 14 1 _ q
REMARKS
8'11 A 6e 10 F:
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING.
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ FT ®
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
=$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
0
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
FIREPLACE
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.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
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 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.
FRAMING
FINAL INSP.
ROOFING
G'/�
/mom � r/ G...•
/
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REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL