05065 (SFD)4
4
P.O. 4 NQ, 05065
BOX 150
Building 78-105 CALLE ESTADO
Address 4.•3 I,.- LA QUINTA, CALIFORNIA 92253
Owner
; BUILDING: TYPE CONST. OCC: GRP.
Mailing -
Address 12-600 Gook St., Suite 2'00 _ _ A.P. Number PGA West mw Phase 40A
Cityp Tel.
Palm Desert 368..-282$ Legal Description
r*92260
Contractor Project Description
Hational MnxtP e "
Address
City Zip Tela
w_
State Lic. City
& Classif. Lic. # S Ft. No. No. Dw.
Arch., Engr.,
28813A 323 Sze 19I€3 Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City 77_7zip 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. It i
SIGNATURE - 'DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following s
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
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 or 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 penalty of not more than rive hundred dollars ($500). '
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. $ 442.73
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. E3
Professions Code: The Contractor's License Law does not apply to an owner of property who •
builds or bnproves thereon and who does such work himself or through his own employees, Mech. 34.00
provided that such improvements are not intended or offered for sale. It, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 74.69
or proving that he did not build or improve for the purpose or sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 5Q
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who bum7ds or improves thereon, and who contracts for S.M,I, A n
such projects with a contractor/s) licensed pursuant to the Contractor's License Law.) Grading 9.L8
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure $2,988.36 1,494.18
Lesa Credit 1.494.18
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 S 2 .6 5 T . S 8
CERTIFICATE OF EXEMPTION FROM REMARKS -
WORKERS' COMPENSATION INSURANCE
(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 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 E
"NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply wflhsuch provisions orthis permit shall bedeemed revoked. Minimum Setback Distances:
Front Setback from Centel 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, CW Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out signed and validated, and is subject to 12 % 2 e
/88
expiration if work thereunder is suspended for 180 days. 4v
1 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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
,
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST F►. SQ. FT. ® $
UNITS
SLAB GRADE
ROUG PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIROUGH
WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FINAL)
TE P. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
=$
42 UMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING/,�l i
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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. ® c
BATH TUB
MESH
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
AVP GRADING
SQ.FT.GAR ® 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 6 AIR COND. SOLAR
SETBACK
NO PLUMBING ,Z
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUG PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIROUGH
WIRING
DUCT WORK
ROCK STORAGE
UND. REINF
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
FINAL)
TE P. POLE
GROUT
WATER HEATER
ERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
42 UMBER GR.
FINAL INSP.
FRAMING/,�l i
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
R. FIREWALL
LA HING
MESH
ULATIONISOUN[� 5
AVP GRADING
INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
�
GARDEN WALL FINAL