003033 (BLCK)•44v
I�II�f+7N
P.O. BOX 1504
BuildingAddressss 53-150 Avenida Diaz LA QUINTA CALIFORNIA 92253
Address
Owner
Pedro Land Inc.
City Zip Tel.
Palm,Dezert - .. 92261.. _ 345-7352
Contractor
db�rd ' Glever Cmetruction C01.
Address
P. 0. Box 1702
City Zip Tel."
Palm Deftrt 92261 x-73 2
State Lic. City
& Classif: 473053 Lic. o 78
Arch.,.Engr.,
Dealaner
No. 00333
BUILDING: TYPE CONST, OCC: GRP.
A.P. Number 774-042-000
Legal Desgrlptlon
Project Descrlptlon W of 3 P3gh Retaining Vali
New ❑„ Add ❑ Alter ❑`
Repair ❑
Demolition ❑
Address
Tel.
City
Zlp
State
.
�- N1
Lic. fi-
r LICENSED CONTRACT6llDECLARATION
.I hereby, affirm that I am Ilceneed.under provisions of Chapter 9 (commencing with Section
,7000)' -of Division 3 of,the Business end Professions Code, end my license Is In full force and
reffect. �✓C. t .. .. x +
+
' 9103 ATl1RE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sea 7031.8,Buslnesa end Professions Code: Any city or county: which requires e.
permit to ,construct, alter, Improve, demollsh, ' 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 7031,8 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($800).
❑ 1 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, Sulsness end
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. It, 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 bulld,or Improve for the purpose of sale.) .
Estimated Valuation
7fl.Qr>s}
* ,
PERMIT AMOUNT
-Plan Chk..Dep:..
Plan Chk.:Bal.
COr19t•. .� fnQ.Ci�i
Mach.
Electrical
Plumbing
I O I, as owner of the property, am exclusively contracting with licensed contractors to con.
Strutt the project: (Sec. 7044, Business and Professlons Code: The Contractor's License Low
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.)
.0 1 am exempt under Sec,� B. & P,C, for this.reason '
S.M.I.
Grading
Driveway Enc.
Date / ✓ Owner
Infrastructure
y{ WORKERS' COMPENSATION DECLARATION
t 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
0 Copy Is filed with the city. ❑ Certified copy Is hereby furnished..
II`
TOTAL $20.50
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION. INSURANCE
REMARKS
(This section need not be completed If the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that In the performance of thq work for which his permit Is Issued, I shall not
l employ any arson In any manner so as to become subject to the Workers' Compensation.
Laws of Cellfppornis,
Date Owner
NOTICE TO APPLICANT: 1l, alter making this Ce011trate of Exemption you. should become-
' subject to the 'Workers' Compensation provision" of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. '
ZONE: BY:
Mlnimum'Setback Distances: .
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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
Side Setback from Property Line
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.!7�
- 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.
FINAL.DATE INSPECTOR
Issued by: Date Permit—
Validated by:
Signature of applicant Date
Mailing, Address
Validation:
City, State, Zip
B7b98. 4 7 U,QO 7
HARDCOPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT. ®
HEATING (FINAL)
WALL SO. FT. ®
REINF. STEEL
DRINKING FOUNTAIN
SO. FT. ®
URINAL .
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
I
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
FIRE ZONE ROOFING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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 GOND. 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.
VZBOND BEAM T_�5/—�
WATER SYSTEM
$
GRADING
Cu. yd.
plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
DEC
17
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL