003224 (SFD)TAb
f44
P.O. BOX 1504 No. 003224
Building 78-105 CALLE ESTADO
Address 54-800 Inve3mess LA QUINTA, CALIFORNIA 92253
Owner
su=ise company
" BUILDING: TYPE CONST.
Mailing OCC: GRP.
Address 75-005 Country Club Driir; A.P. Number PGA 't AAt
City Zip Tel. _ .
Palm Desert, . 92260 568-282A Legal Description
Contractor Project Description 10%;55', 10 An * 1 1140
Address
'City Zip . Tel..•
State Lic. City DWG Z32i
& Classif.. 28813€3 Lic. # 12A Sq. Ft. No. No. Dw.
Arch., Engr., -
Size_ GAS ...4�� Stories- Units
Designer New ❑ Add ❑ Alter ❑. Repair ❑ Demolition ❑
Address Tel. -
City Zip State
Lic. #
,• LICENSED CONTRACTORES DECLARATION
I hereby affirm that I am licensed under provisions of,Chapter 9 (commencing with Section
7000) of Division 3sof the Business and Professions Code, and my license is in full force and a;
effect✓/if,� T .i DT rf/{�% /.. le -
SIGNATURE ' " ,I DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
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 aS11-1.727-0
permit to construct, alter, 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 penalty of not more than five hundred dollars ($500).
❑ 1, as ownerof the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. S'. 380.4A
do the -work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. • n
Professions Code: ;The Contractor's License Law does not apply to an owner of property ,who a
_ 68. 04
builds or improves`. thereon and'wbo does such work himself or through his own employees, Mech.
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
of proving that he did not build or improve for the purpose of sale.) _ IG7
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 87, 517
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: - .19
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑.I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure id}�at 91
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
• TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
.WORKERS'.COMPENSATION INSURANCE it $• r[ rt
(This section need not be completed if the permit is for one hundred dollars ($100) valuation Vii�Y't"Af% k i��.11no,.
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.
Date Owner -
NOTICE TO APPLICANT.-. If, after making this Certificate of. Exemption you should become ZONE: BY:
subject 'to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
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 PrOpefty 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
expiration it work thereunder is suspended for 180 days.
I cedify that I have read this application and state that the above information is correct. Issued by: Date % / 15 %R 0ermit
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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. p $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR.. SO. FT. @
CAR P. I SQ. FT.
WALL SQ. Fr. ®
SO. FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
SLAB GRADE � !
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH) �� 9
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
WATER HEATER
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/ac
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 PL MBINGNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE � !
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI T
ROUGH WIRING
DUCT WORK
ROCK STORAGE
A
FOUND. REINF.Z� .!//
,
GAS (ROUGH) �� 9
�/ METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL) m
, P. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
LUMBER GR.
FINAL INSP. 12,111m
Z 1
FRAMING�D
AL INSP.
i-$_plus_x$_=$
ROOFING /� T� i /
VENTILATION��
D�
/
/
/
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE .FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL