14875 (SFD)%�rfti1 mit/ .
Tih
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 45-629 Calle E speranza LA QUINTA, CALIFORNIA 92253
P.oger . Shellenbesges & Associates
Mailing
Address 41-8 5 Boardwalk #212
City Zip .:[Tel.
Palm Desert, �... 92211 I�19") 777 7366
Sai de
Zip.
State Lic.
& Classif. B 489234
Arch Engr `
No. 14875
BUILDING: --TYPE CONST:. <` 1 OCC: GRP. 3
A.P. Number 6463-=_ 21,015
Legal Description 1�t -I5 Tact 20052•-4
Project. Descriptions Plan 2
City
Lic. # Sq- Ft- 19550 No. No. Dw
Size Stories ' Units.
Designer
Carios"- i as Engineer New ❑ Add ❑.
charier -worth Dr. ti9)328-7271
!CityZi State
Cathedka�.. t:3 ty' 92234 Lic. #
-LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisl'ons of ha ter 9 (calmmencing with Section
:{{{{7000) of Divlsiom3 of.th!3usiness and Prof ions and my,lcense is.in full force a dd
effect• /ice; r•fA/i l%� +��^^ a Y— ?
f SIGNATURE �y— DATE
OWNER -BUILDER DECLARATION Estimated ValuationX�11 Ay
I hereby affirm that I am exempt from the Contractor's License Law for the following f31 15 7J�i 0�
reason: (Sec. 703,1.5,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 /or such permit to rile a signed, statement that he is licensed. pursuant to PERMIT
• the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
Division 3 ofdhe Business and Professions Code, or that. he is exempt therefrom, and the.basis.y
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit • . Plan Chk.' Dep. ri -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). . - Plan Chk- Bal.. a
Alter ❑ Repair ❑ Demolition ❑ .
❑ 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 Law does not apply to an owner of property who
Const.
`4
' Mech. '
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
Electrical
j 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 of sale.) -- -
Plumbing.,. - r
❑ I, as owner of the property, am exclusively contracting with: licensed contractors to con-
truct the project. (Sec. 7044, Business and .Professions Code: The Contractors License Law
does not apply to, an, owner of property *who builds or improves thereon, and who contracts for -
_
S.M.I.
' ch projects with -a contractors) licensed pursuant to the Contractor's License Law:)
❑ 1 am exempt under Sec. • B. 8 P.C. for this reason
Grading
Driveway Enc.
Front: Setback from Center Line `
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
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.)
Pot
ic�N(p� Company
O'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
Arts in min c_, F.i,
TOTAL
REMARKS
AMOUNT
SS5.53
695.50
62.00
140.95
150.00'
11.59
20.00
.00
2,585.27
39.05
' employ any parson in any manner so as to become subject to'the Workers'.Compensation
Laws of California
Date - Owner
NOTICE TO APPLICANT: ff, after making this Certificate of Exemption you. should become '.
-subject "Compensation
ZONE:
BY: -
to the Workers' provisions of Me•Labor Code,* you must forthwith
comply with such provisions or this permit shall be deemed revoked. •. --
Minimum $etback Distances: '
Front: Setback from Center Line `
Rear Setback fromRear Pr ine
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND.
- - " '
- Side Street SetbaCK fro ter e -
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,
Side Setback from Pro .Line
DAMAGES AS PROVIDED FOR IN' SECTION 3706 OF THE LABOR- CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE
7 N { CTQ
This is'a building permit"when properly filled out, signed and validated, and is subject to
it is for
expiration work thereunder suspended 180 days-
I
certify that I have read this application and state that the above information is correct.
Issued by:
Dat' P rAt%
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-:•
for inspection
mentioned.property purposes:
Validated by:
Signature of applicant Date
'
} Mailing Address -- -
;;m.M ,.
Validation:
City, State,- Zip .
,-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIIQ FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT. p
SLAB GRADEROUGH
YARD SPKLR SYSTEM
PL MB.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
ROCK STORAGE
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (RO GH)4 12,64 FA
METER LOOP
WALL SO. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN
SO. FT. a
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
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
FIREPLACE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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 fiLECTRICAL HEATING & AIR COND. SOLAR
SETBACK
(
GROUND PLUMBING
,
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEROUGH
PL MB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWE
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (RO GH)4 12,64 FA
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATE
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
g plus x$
_$
LUMBER GR.
FRAMING
ROOFING I
dC
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREW L
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC. \\\
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
7d