04974 (SFD)Building
Address 54_350 Z
Owner
Sl�xrr�►��
Mailing
Address
City _ Zip
Palm Danelrt
Contractor
_ tda Y i mar ss l
Address
City _ Zip
State Lie.
&Classif_ 2,88130
Arch, Engr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
. .
ri' r
City
Lic. If
Tel. .
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1atTmn Umt l an d under provisions of Chapter 9 (commencing with Section
7D00) of buvnsfmw ri3� the �roess and Professions Code, and my license is in full force and
SIGt1ATIWIE -T - r _ DATE
OWNER -BOULDER DECLARATION
1 Iremebyl affirm Umat I an exempt from the Contractor's License Law for the following
masOm (Sec 7031-6,Bra ftw and Prdessiars code: Any city or county which .requires a
Permit tm cmmstrr cL af4er, armee, demolish, orrepair any structure, prior to its issuance also
requires Fhe appy tion such peord to We a signed statement that he is 'licensed pursuant to
Ore provisions of fits C=Dacmr5 License law, Chapter 9 (commencing with Section 7000) of
l7lmsnan 3 at Oce f3Wsherss and Platesshrs Code, or that. he is exempt therefrom, and the basis
for flee aged ezermpftn. Any vin of Section 7031.5 by 'any applicant for a permit
srtoecs fits apptfart ft a ciW penalty of not more (flan five hundred dollars ($500).
0 I, as owner at the property, or my employees with wages as their sole compensation, will
do the wort[, and the structure is not intended or offered for sate. (Sec. 7044, Buisness and
Rdessmms, Code. The lis license Law does not apply to an. owner of property who
buaiS or & gramvcs Eheremn and who does such work himself or through his own employees,
Prover/ OW such dro o>o are not irdermded or offered for sale. If, however, the building
or improvement Is Sall willdn arta •year of completion, the owner -builder will have the burden
. otprovmillp chat be did nal bofDd or improve for the propose of sale.)
® 1, as owner of Ute paopefly, an exclusively contracting with licensed contractors to con-
' stud the projecL fS= 7044. Brrsaress and Professions Code: The Contractor's License Law
does ret apply fm an owner of properly who bods or approves thereon, and who contracts for
such p+ with a caa0acWs) flimisedpursuanttotheContractor'sLicenseLaw.)
O 1 am exempt undw Sec --------R & P.C. for this reason
Date Owm w
WORKEW COMPENSATION DECLARATION
1 hereby affufm dial 1 have a certificate of consent to self -insure, or a certificate of
workers Compensatiori Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Put'" NQ spa„ y
0 Cupy is Tiled with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKEW COMPENSATION INSURANCE
sec6mn nerd ret he cornmilOed 9 the permits for one hundred dollars ($100) valuation
1 certify that in the perfamearce of ft work for which this permit is issued, I shall not
ermplryt any person in any manner so as to become subject to the Workers' Compensation
laws of ca iton�
DIMP .Owner
N0710E 70 APPLOCAM. 8; afro making this Certificate of Exemption you should become
sxmbjeQ o the MMEFs' Ce>,Pansation Provisions of the Labor Code, you must forthwith
canply with such pewfeimas ar Oils peme7 shall be deemed revoked. .
CONSTRUCTION LENDING AGENCY
I hereby affirm Ural there is a construction lending agency for the performance of the
Work for width this pard is issued (Sec. 3097, Civil Code.)
Lenders Nance—_
Lenders Addrers
. Tbs is a buifrftV permit when properly filled out, signed and validated, and is subject to
expiration it waft thereunder is suspended for 180 days.
I certify that I fmae read Uds applicafion and state that the above information is correct.
I agree to cmyWIy vitt all city and county ordinances and state laws relating to building
cOnsbucUM and hereby aw"Kirrize
purposes, representatives •of this city to enter the above-.
mentiorned Prop" for inspectit-SW at re of appfirarvrt Date
Mailing Addxcss
City, Stag Zm
N0. 04974
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PGA Went. Tract 22432--2
Legal Description
Project Description. Phase- 26n. Plan 30MR
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. 2823
Size.,IAV
No.
Stories
No. Dw.•
Units
New ❑ Add.❑
Alter ❑ Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Datelz`$/$ Permit
Validated by:
Validation:
Estimated Valuation
094,692
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
fi r
Const.
4
Mech.
Electrical
` T y
Plumbing
5t1
S.M.I.
Grading
Driveway Enc.
Infrastructure
54.380.57
? I90,29
(`V#74
2q
TOTAL
A3_ b 2
REMARKS
ray
4�ii?.)1? hfll-4 yi.
ar�� ,( rr''i�
44-1RWA i 7q!; Y.
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:
Datelz`$/$ Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMSER
O SEPTICTANKROUGH
JW
WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. a
ROUGH) y/ Z
•�
METER LOOP
GAR. SO. FT. a
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. Fr. a
GROUT
WATER HEAT
WALL SO. FT. a
FINAL INSP.
DRINKING FOUNTAIN
SOFT 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
LAUNDRY TRAY
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.
SO. FT. a c
BATH TUB
Z(ATHING
SQ. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 1% c
SEWAGE DISPOSAL
SO.FT.GAR a 3Yic
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSER
O SEPTICTANKROUGH
JW
WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
ROUGH) y/ Z
•�
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEAT
R E
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUM R GR.
FINAL INSP.
MING / —
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G R. FIREWALL
71
Z(ATHING
MESH
INSULATIONISOUND
'jfflISH GRADING
AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINtT1ALS
GARDEN WALL FINAL
1