04980 (SFD)s •
4
tu��ctc�
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-296 Inverness LA QUINTA, CALIFORNIA 92253
Owner • I'
Mailing
Address 42-600 Cook St
City Zip
Palm Desert 1 92260
Contractor
.. Address
City Zip
StateState Lic.
& Classif. 288130
WK
Suite 200
Tel.
5b€�-7fi28
IT -1
No. 04980
WILDING: TYPE CONST. OCC: GRP.
>.P. Number PGA Weat _ Tract 22432-2
_egal Description
)rojectDescription Phase 2$B. PlsPlan.10HR
. T
City
Lic. # 320 _ Sq. Ft. 2272
iSizer-4-An +CQ9
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70(10) of Division 3 of the Business and Professions Code, and my license is in full force and
effect t SJ r'
SIGNATURE- -- .. - - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busimess and Professions Code: Any city or county which requires a
permit to construct, -after, improve, demolish, or repair any structure, prior to its Issuance also
requires the appicad fdr such permit to Ole a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Ofvfsfon 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
suhjects the applicant to a civ8 penalty of not more than five hundred dollars ($500).
❑ 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
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. It, however, the building
Of 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.)
Cl 1, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I he -by affirm that I have a certificate of consent to self -insure, or a certificate of
Work
er's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Cpmpany
❑ Copy is filed with the city. ❑ Certified copy is 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 fess.)
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: ff. after making this Certificate of Exemption you should become
subject to the workers' Compensation provisions of the Labor Code, you must forthwith
campy with such provisans or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
Lenders Address
This is a building permit when propedy filled out, signed and validated, and is subject to
expiration it 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
ateMailing Address
city, State, Zip
No.
Stories
No.. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
158,646
$158,646
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
C
A K A
Const.
S .
Mech.
Electrical
14 2 17
Plumbing
28 50
S.M.I.
Grading
Driveway Enc.
Infrastructure
U.569.53
j734.77
TOTAL_Ili7_A
REMARKS
ZONE: BY: I.. 14MT i �,. r .oaf
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 12,g/$`rPermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.' SQ. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. a
FORMS
S ER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH)�lZ
METER LOOP
GAR. SQ. FT. a
POWER OUTLET
ROOF DRAINS
AL)
TE,,P. POLE
DRAINAGE PIPING
CAR P. SQ. FT. a
GROUT
WATER HEATS
WALL SQ. FT. a
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT a
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
VENTILATION
ILAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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.
SQ. FT. a c
BATH TUB
LATHING S
SQ. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 1% c
SEWAGE DISPOSAL
SO.FT.GAR a 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 R AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
S ER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.GAS
ROUGH)�lZ
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AL)
TE,,P. POLE
GROUT
WATER HEATS
ERVICE gO
i
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
AMING
FINAL INSP.
OOFING '-�—)(—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING S
MESH
IYSULATIONISOUND —Z7
FI"H GRADING
NAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
1