14743 (SFD)P.O. BOX 1504
78-495 CALLE TAMPICO
Address 48-607 Calle `'` peran'za LA OUINTA, CALIFORNIA 92253
Roger Sne.l.lenberger t Associates
Mailin
Address 41-y865 Boardwalk #212
Cityp
Palm Desert, CZi92211 (619)777-7766
Contractor - ~
Sam
Address
City - lZip Tel.:
State Lic. City
& Classif. 13 488234 Lic. # 1858
Arch., Engr.,
Designer Carlos Engineer
el
Charlesworth Dr. 1*13)328-7271
City ripc State
:.athtedral; CityA 32234 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am,licensed and Drovls%ns of G'�ap at 9 (comfnencing with Section
y000) of Division 3 of th Business an Profeeions C e nd my licjmmse is in full force and
ieffect. ar �.�-
SIGNATURE - e DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec.. 7031.5,Business and Professions Code: Any city or county which, requires a
permit to construct. alter, Improve, demolish, or repair any structure, prior to.its issuance also
requires the applicant for such permit to (le 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 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
0.1, as owner of the property, or my not
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 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 -builder will have the burden
of proving that he did not -build or Improve for the purpose or sale.)
❑ I, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I heregy affirm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's •ompensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
PoIIcY, o• Company
:.Copy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(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 the work for which this permit is issued, I shall not
employ any ppeon in any manner so as to become subject to the Workers' Compensation -
Cal ifornirsa.
Date Owner
NOTICE TO APPLICANT: g, 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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 1 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. 14743
BUILDING: TYPE CONST. YN . OCC. GRP. R3
A.P. Number 646-121-004
Legal Description Lot 4 Tract 20352- 4
Project Description . 1
Laguna De Paz
Sq. Ft. No. No. Dw.
Size 2.852- - Stories Units
New ❑ Add ❑ Alter ❑ Repair.❑ Demolition ❑
Estimated Valuation $111,430.00
PERMIT
AMOUNT
Plan Chk. Dep.. „
Plan .Chk. Bal.
576.17
Const.- ,
681.50
Mech.
68.50
Electrical
137.04
Plumbing
150.00
S.M.I.
11.14
Grading
20.00
Driveway Enc.
.00
Infrastructure
2,462.89
Arts in Publi.- Places
-18.58
TOTAL
4,135.82
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from. Rear Prop. Lin
Side Street Setback from Cen
Side Setback from Prope e
FINAL DATE INSPE
Issued by: Date ermit
Validated by: 1O
Validation: AA
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
Y
ARD SPKLR SYSTEM
2ND FL. SD. FT. p
FORMS
SEWER OR SEPTI
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
/
FRAMING / 7
/'
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(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, 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 ® 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 _ A ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBI NO,UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
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 / 7
/'
FINAL INSP.
ROOFING
/ r7
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND G
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL