003244 (SFD)�1
P.O. BOX 1504 No. 003244
Building 78-105 CALLE ESTADO
Address .54-841 Inverness LA QUINTA, CALIFORNIA 92253.
Owner - ...-
Mailing
Address � � ("'I ImI,
BUILDING:. TYPE CONST.
A.P. Number
Legal Description
-V1=:�Adi3
Project Description
OCC.GRP.,
WZA 1"URg4-
pa+�r► y7' Xk
.
City
-Palm Desert.
Zip
9226;
Tel.
560-2822
.Contractor
'Natlostal Mortgage Land
Address . �.. "•
Side Setback from Property Line
Lender's Name
City
Zip
Tela _
FINAL.DATE
INSPECTOR
State Lic.
& Classif. 2881301
City
Lic. # 323
Sq. Ft. LAM2825
Size GAR -458•
No. No. Dw.
Stories Units
Arch., Engr:, _
Designer
New ❑ Add ❑
Alter ❑' Repair ❑ Demolition ❑
Address
Tel.
construction, and hereby authorize representatives -of this city to enter the above-. -
City
-
Zip
State
Lic. #
Signature of applicant Date
-• LICENSED CONTRACTOR'S DECLARATION_ _
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divisiori 3 of the Business and Professions Code,' and my license is in full force and
effect. .� i. r> f s A ...T` �`r, - �.irr ' 1 1 % .
Validation:
• SIGNATURE -. - DATE
OWNER -BUILDER DECLARATION'
I' hereby, affirm that I am exempt from the Contractor's License Law for the following
reason:' (Sea 7031.5,Business 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 applicant for such permit to file a signed statement that heis licensed pursuant to
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
subjects the applicant to acivil'penahy of not more than'five hundred dollars ($500).'
0 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. 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.)
❑ 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
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.) --
❑ I am exempt under Sec. B. & P.C: for this reason
Estimated Valuation
�iy • �+0�
sz 94
-PERMIT - • AMOUNT
Plan .Chk. Dep.
'
Plan Chk. Bal. $ 555.10 _
COrjst. •
_
Mech.' - .f�
55.01)
Electrical 17.1, 1
„
Plumbing 136
50
S.M.I. 1-3.62
Grading
Driveway Enc.
Date Owner '
Infrastructure
2,000.00
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 -I . S rj 2 . 43
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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 !' '
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.
REMARKS
ZONE: BY:
Minimum Setback Distances:
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 Property Line
Lender's Name
Lender's Address
This is a building permit'when properly filled out, signed and validated, and is subject to
FINAL.DATE
INSPECTOR
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. -
Issued by:
Date 7117 / A 7 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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. Fl.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
'
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMITTEE
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL