05251 (SFD)4.4 a
u`��N
P.O. BOX 1504 No. 05,251
Building 78-105 CALLE ESTADO
Address 4R-105 VIA Re masa LA QUINT& CALIFORNIA 92253
Owner
Mailing
Abe & T$e.lma Grow fman A BUILDING: TYPE CONST. OCC: GRP.
Address
Orlin rnrhin Atr A.P. Number {sl 7—F�t►f'f—I
City Zip Tel.
>; ; � ! itt Y ""$` A Legal Description
Contractores� - �
Project Dcription���'3 � A � T, ►� t- o
James 'Cashman/Steriiux Cnli't.
Address
779200 Hinnesota
City Zip Tela
Palm Desert 1 92260 345-.5430
State Lic. City
& Classif. 19533 Lic. # Sq. Ft. g No. No. Dw.
Arch., Engr., Size - Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby,affirn that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Coft-a M my license is in full forceantd,
effect
.SIGNATURE '• - - r"" "<� C. - tr,^w.-_• A ✓}' W11E
OWNEWBUILDER DECLARATION rAOe
.Thereby affirm that I am exempt from the Contractors License Lawj for the following Estimated Valuation
reason: (Sec. 7031-5.6usiress and Professions Code: Any city or cmilfy wlrh reglies a
Permit to construct, after, improve, demolish, or repair any sbucbse, pdor to as svalce also AMOUNT
requires Me applicant for for such permit to rile a signed statement that hes licensed pusuarR to PERMIT
the provisions of the Contractor's license Law, Chapter 9 (co mmenriug will Section 7000) of
division 3 of the Bumsiness and Professions Code, or that. he is exempt therefrom, and the basis Plan Chk. De
for the alleged exemption. Any violation of Section 7031.5 DY any applicard for a permit p.
subjects the applicant to a chid penalty'of not more than five hundred dollars (5500).
❑ I, as owner of the property, y employees g compensation, will Plan Chk. Bal. t 369.83
p perry, or m em to eros with wages as their sole
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bisness and 1,
Professions Code: The Contractors License Law does not apply to am owner of property who Const. ,;r�.� •'�� .
builds or improves thereon and who does such work himself of through his own enpbyees,
provided that such improvements are not intended or offered for sale- B, however, the buri3'ng Mech.- '39.uv
or improvement is sold within one.. year of completion, the owner -budder w7 have Me burden Electricalj,�,
of proving that he did not build or Improve. for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 9 •
struct the project (Sec. 7044, Business and Professions Code: The Contractors License Law -
00
does not apply to an owner of property who builds or improves thereon, amd who cordracts for S.M.I.♦
such suprojects with a contractors) ficensed pursuant to the Contractor's License Law.) r E
Grading
❑ I am exempt under Sec 8. 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure 2.300.09
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec- 3800, labor Cede-)
Policy No. mpany '
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished
TOTAL 9 469 I0
CERTIFICATE OF EXEMPTION FROM REMARKS Y
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred doffs (5100) raietion ' ; e ., . %�i..P4-e r 10
or less.)
1 certify that in the performance of the 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 Owrier'
NOTICE TO APPLICANT: ff, after making this Cerokate of Exenplion you shorn hecmme ZONE BY:
subject to the Workers' Compensation provisions of the Labor Codeyou must forthwith
cmnpy with such Provisions or Mts permit shall be deemed revoked. Minimum 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, CW Code.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INSPECTOR
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. 12130188
1 certify that I have read this application and state that the above inform a ion is correct- Issued by- Date Permit
I agree to comply with all city and county ordinances and state laws relating to building y
construction, and hereby authorize representatives of this city to enter the above
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address— Validation: -
City, state, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SQ. FT. ® $
UNITS
LAB RADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)V A
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
WALL SQ. FT. ®
WATER SYSTEM
INAL INSP.
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
URINAL
SQ FT ®
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSPECTION
SQ.FT.GAR ® 3/ic
HOUSE SEWER
CERT. OCC.
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
BACK
IF
UND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB RADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)V A
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
INAL INSP.
FINAL INSP./0 Y �9
(
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING 6 (/ �/
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING �(%� 7/3
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
t