003267 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-821 inyernCS8 LA QUINTA, CALIFORNIA 92253
Mailing -
Address 75-005 Country Club Drive, .
City Zip Tel.
Palm Dezert 32260 1 568--2828
Contractor
ress
State Lic.
& Classif. 288330
Arch., Engr:,-
Designer
Address
Tela
Lic'. # 328
Tel.
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. Y �/
SIGNATURE~ DATE
OWNER -BUILDER DECLARATION' Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following J j �i rij
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
NO., 003267
BUILDING: TYPE CONST. OCC. GRP.'
A.P..Number _ P" West
Legal Description
Project Description _ . -238, glary 20MR
Sq. Ft. &G 2596 . No.
Sizeti�t 557'? •Stories
New ❑ Add ❑ Alter. ❑
• requires the applicant for such permit to file a signed statement that he is licensed. pursuant to
the provisions of the Contractor's License Law, Chapter9 (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 apermit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
O 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
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. If, however, the building,
or 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.) '
.,. PERMIT '
'
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
'Electrical
Plumbing
❑ I, 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 -
S.M.I.
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.)
. 0 I am exempt under Sec.. B. & P.C. for this reason
Grading
Driveway Enc.
FINAL DATE
. Date Owner
WORKERS' COMPENSATION DECLARATION
A 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.
CERTIFICATE OF EXEMPTION FROM
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 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
subject -to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if 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 Address
City, State, Zip
HARD COPY
No. Dw.
Units
Repair ❑ Demolition ❑
AMOUNT-
633.00
MOUNT•633 00
1 11.- t1 A
' RO
fi U7
Infrastructure 2 _ nnn no
TOTAL C - A71 _ 2'1
REMARKS
4.*si5,f �• ;� t:1'.�;l�,tf�...,tt•� "r�.�t4 r� . �� t
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:
Date •°r -?Al A7P,ermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. Sp. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P.. Q. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL. SQ. FT.
OTHER APP./EQUIP.
DRINKING FOUNTAIN
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN -
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
IKITCHEN 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
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT,-B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® V4c
HOUSE SEWER
LATHING
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
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
mbrcc i un a aiumm p uneanmmww.
GARDEN WALL FINAL