05501 (SFD)P.O. BOX 1504 No. 05501
ZBuilding 78-105 CALLE ESTADO
dudress 48`115 gieta Ciel LA QVINTA, CALIFORNIA 92253
Owner
Thelma Grosal�XYt
BUILDING: TYPE CONST.
Mailing OCC: GRP.
AYddress 9010 Corbin Ave. 3.3 I A P. Number .617-640-050
CityTel. Lot 50I aiOrtlhrid;Zip3137.4 18-18/349-5894 Legal Description
Contractor Plan 3
y . Project Description
Address
f 77-200 Hisrnaaot
City Zip Tel.:
Palm Desert 9226.0 619-345-5430
State Lic. City
&'Classif. B 195333 Lic. # 260 Sq. Ft. No. No. Dw.
Arch., Engr., Size W 1852 Stories Units
Designer New 4B Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address' Tel.
1.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I 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.
effect.fiR'^'
SIGNATURE ,r DATE
OWNER -BUILDER DECLARATION Estimated Valuation $10296
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, atter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for 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) 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 Plan Chk. Dep.
subjects the applicant to a civil penally of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech. - 60
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 Electrical 111.12
of proving that he did not build or improve for the purpose of sale.)
❑ I, as' owner of the property, am exclusively contracting with licensed contractors to con- Plumbing%i-44.5U
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 - S.M.I.+d
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.).
❑til am exempt rider Sec B. & P.C. for this reason Grading
u
Driveway Enc.
Date
i owner Infrastructure �3
1 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.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section neednot 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 person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, alter making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Set back Distances:
i 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, Civil Code.) Side Setback from Property Line
Lender's Name
t
Lender's Address '
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days. 3,114/69
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Vdlldatcd by:
Signature of applicant Date
Mailing Address Validation: r
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. p
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
I
WATER PIPING
NOTE: Not to be used as property tax valuation
FRAMING
FLOOR DRAIN
MECHANICAL FEES
/
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(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, 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 ® 1+/. c
SEWAGE DISPOSAL
INSULATIONISOUNDS
FINISH GRADING
SO.FT.GAR ® 3/.c
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 ..4 /4 y ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
GROUND PLUMBING Leo
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. y
G
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
FINAL INSP.
ROOFING
v
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING Ot W 9(: /l
MESH
INSULATIONISOUNDS
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL