11547 (RPL)i
P.O. BOX 1504 N 0. 11547
ot1r1ap�9 45-390 DESERT FOX DRIVE LA QUINOTACCAL FORNIA 92253 � f
Owner
SANTA ROSA DEVELOPERS
Mailing
Address 45-275 DESERT EAGLE COURT
City Zip Tel.
LA QUINTA 1 92253 345-1216
Contractor
DSON CONSTRUCTIOhi
City Zip Tel.:
CATHEDRAL CITY 324-1232
State Lic. City
& Classif. 578127 A Lic. # 1044
Arch., Engr.,
Designer
Address Tel.
City( Zip ( State
Lic. #
'LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of tyhVBusiness and Professions Code, and my license is in full force and
effect. /%yi�p'.vr //_ /.�,7
SIGNATURE°r / J' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a �!
Kil
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description POOL AND SPA
Sq. Ft. No. ,_.Ro.,Dw.
Size Stories Unit's
New O Add ❑ Alter O Repair ❑ Demolition O
Estimated Valuation $15,600
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
�`h PERMIT
mss1
•'" AMOUNT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
-
i Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, and the basis.
for the Any Section 7031.5 'any for
,
Plan Chk. Dep.
alleged exemption. violation of by applicant a permit •
'subjects the applicant to a civil penalty o/'not more than live hundred dollars ($500).
Plan Chk. Bal.
$105.30
O 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
Const:
16 2.00
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, •
'Meeh.
4 • %)Uprovided
that such improvements. are not intended or offered lor•sale. If, however, the building .
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
45.`x®
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-
Plumbing
; 27.00
slruct the project. (Sec. 7044, Business. and Professions Code: The Contractor's License Law
1
does not apply to an owner of property who builds or improves thereon, and who contracts for
- S.M.I.
1 . 50
- such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
T� ,
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that (.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. . ❑ Certified copy is hereby. furnished.
TOTAL
$364.80
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
REMARKS
:r•�,+n^.
�r
(This section need not be completed i/ the permit is for one hundred dollars ($100) valuation
4V f' - " 'tY13Si1 L' 11T If KE. X pO�f s OiJ
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, alter making this Certificate of Exemption youshould become
ZONE:
BY:
subject to the Workers'"Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
. CONSTRUCTION LENDING AGENCY
I hereby 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 Address
City, Stale, Zip
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. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. 5Q. FT.
FORMS
SEWER OR SEPTIC TANK
POR 5Q FT @MOBILEHOME
SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL 50. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
/
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11% c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3Lc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 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.
FRAMING
FINAL INSP.
ROOFING
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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