14323 (SFD)P.O. BOX 1504 No. 1.4323
Building 47L515 Via Montigo 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
vwnci Dilsaver
' Mailing 154 Desert Falls Dr. E.
Address
Citya3Yfi Desert, .lik 92211 ]TtO-3' 22
C�e raj °f Z Construction
Adladdr ss• ..
Desert flallis Dr. E.
Tel.:
halm Desert, 92211 340.352.2
State Lic. City 4
& Classif. $- $0530 Lic. # 4579
Designer 9r, John W,311 ng
Address Te .
49yn. °Glum brive 60--0250
City- Zig State
Indk3ty Wells; L�Ik Lic. # 67424
VdENSED CONTRACTOR'S DECLARATION
I hereby affirm that I licensed under provisions of Chapter 9 (commencing with Section .
7000) of Division,3 of t e urine agd Profs$siong Cp�e, and my license is in full force and
effect. l �!/9/d/f/[.�f1
OWNEWBUILDER DECLARATION :
I hereby affirm that.1 am exe'mpt.from the Contractors License law for the following
reason: (Sec. 7031.5,Busl7ess--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 rile a. signed statement that' he is licensed pursuant to
...the ' provisions of the Contractor's License Law, Chapter 9`(commencing wlth: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 or Section 7031.5, by 'any applicant for a permit
subjects the applicant to a civil penally of not more than rive hundred dollars ($500).
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, Bussness 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. ff, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden •
or proving that he did not buildor improve for the purpose of sale.) . -
O 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 contractors) (lcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. ' Br 9 P.C. for this reason-
Date Owner
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. (Seco 3800,. Labor Code.)
Policy No. Company
❑ Copy is filed with the city, : O Certified copyis hereby furnished.
CERTIFICATE OF EXEMPTION -FROM '
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff 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
-wa Date Owner
NdT10E-,To APPLICANT. ff, 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'. COMPENSATIONCOVERAGE IS UNLAWF.UE, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100.ODO), 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 property filled out, signed` and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I car ify,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
11LDING: TYPE CO'. NST. V OCC:, GRP. R3
P. Number 643-1.20-026
-gal Description Lot' .254 Tract 26152
oject Description SIM
Sq. Ft. 3$7Noy No. Dw.
Size Stories 'Units
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
Permit does. not incluAe block watts os
Estimated Valuatio$236,985.00
PERMIT
AMOUNT
Plan Chis`:bep:
,Plan Chk. Bal.
689.3$
Const.'1.1119.00,
Mech.
122.00
'Electrical-
223.67'
Plumbing
211.50
S.M.I.
23.70. ..
Grading
20.00.,
Driveway Enc.
2 00
Infrastructure,074.80-
(i%4.$Q-
Arts
Arts in --Publ c' .Places
39.2.45
.TOTAL
6, 076.51
7,$.��?.�32.V;
REMARKS
ZONE:' BY:
Minimum Setback Distances: I ^ r
Front Setback f o e I
Rear Setback tom PYoL
Side Street S tback from Center Line,
Side Setback friofn,Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU
UNDERGROUND
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
'WALL S0. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
I URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH) ?/
/
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEOUIP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 1 V. c
SEWAGE DISPOSAL
FINAL INSP. �Q g
SO.FT.GAR ® 3Y.c
HOUSE SEWER
-
ti
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 j HEATING & AIR COND. ISOLAR
SETBACK
UNO PLUMBINVAA _
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 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. �Q g
n, n
FRAMING
FINAL INSP.
=ROOFING: j
ti
r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
�f7
LATHINGOr
MESH
INSULATION/SOUND 7iJ
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL