05235 (SFD)P.O. BOX 1504 No. 05235
Building 78-105 CALLE ESTADO
Address 48-129 Via $ermost3 LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.-
Mailing
Address . A.P. Number 637-640-007
CityZip Tel.
Legal Description
Contractor
• Project Description Plan. 2D:. List 7
Address - ' r
a
City Zip
Tela
.Palm Desert 92260
345-543.4
State Lic-
City
& Classit.
29 333
Lic- #
S Ft.
Size, Iti� �.
No. No. Dw.
Stories Units
Arch:'Engr.,
,
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Designer
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm. that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license -is in full force and
r fi^
effect. ro y /"- f /" I11
SLGNATUREb'z+..�.r,,.r,,,,,. :. �.. . _ y .,-qr,.� /.J r"'r 4 jr 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, after, improve, demofish, or repair any structure, prior to its issuance alsorequires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provisions o1 the Contactors License Law, Chapter 9 (commencing with Section 7000) o/
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 avil penally of not more than rive hundred dollars .(E500).
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
Professions Code: The Contractors 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 Nat 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 Writs or improve for the purpose of sale.)
Estimated Valuation
$100,928
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
liOrlSt.
/A li
Mech.
_
Electrical
7
Plumbing
43A nnstruct
O I, as owner of the property, am exclusively contracting with licensed contractors to corn
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.)
O I am exempt under Sec. R. & P.C. for this reason
S.M.1.
Grading
Driveway Enc.
Date owner
Infrastructure
2 ^ 2 . 8
Rxin;e-Tee,
Lizarditt
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 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. CDmpany
O Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL - --
S. _ h 1 R _ 2 f1 ��✓ f e '
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 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 mating 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. '
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, State, Zip
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center, Line
Rear Setback from Rear Prop Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date ii.;/3�� Permit
Validated by:
Validation:
1, .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
S GRADE Zf
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
HEATING (ROUGH)
STORAGE TANK
RMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
I POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
S (FINAL) 7C
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN.
SO FT ®
WATER HEAT R
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ -Plus-X$-=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING �� e
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
LATHING OF9
6112�
SO.FT.GAR ® 3/ic
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 COND. SOLAR
SETBACK
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
S GRADE Zf
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
RMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)!
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
S (FINAL) 7C
TEMP. POLE
GROUT
WATER HEAT R
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP. �t"�
FRAMING Lt
FINAL INSP.
ROOFING �� e
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING OF9
6112�
MESH
INSULATIONISOUND 106
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I