003216 (SFD)Building
City
Address
q7 2
Owner
Sq. Ft. No. No. Dw.
Size- 424Stories
Arch:, Engr.,
C.S'A 7M1 T'E '►!
Mailing
Designer
Address
75-005
City
. PalmDeser.
Contractor
City
Zip
Address,
P.O. BOX 1504 No. 003216
78-105 CALLE ESTADO
Pam LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
C4nntXX Club Drive - A.P. Number - MA
Zip Tel.
92960 J5 -68-Z928. Legal Description
Project. Description Plias' ieA.. PZan 3h%
aI Martaaaa and Land
Zip Tela
State Lic.
City
��2�
& Classif. 288130
Lic. # 328
Sq. Ft. No. No. Dw.
Size- 424Stories
Arch:, Engr.,
v - • Units
Designer
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. # _
LICENSED CONTRACTOR'S DECLARATION ,
I hereby affirm thall am licensed under provisions of Chapter 9 (commencing'with Section
7000) of Division3,of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE- ^'•---* -'� •� _ - - - ' .+' DATE
OWNER -BUILDER DECLARATION
_
Estimated Valuation
1 hereby affirm that I am exempt from the Contractor's License Law for the -following
1 sry
reason: (Sec. 7031,5,Business and Professions Code: Any. city or county which, requires a
w L J w L s V V '
peimit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
. . ..
requires the applicant for -such permit to. file 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) of
•.r
Division 3 of the Business and Professions Code, of that. he is exempt therefrom, and the basis
for the alleged Any Section 7031.5 by'any•applicant /or
PIanChk: Dep...
exemption. violation o/ a permit
subjects the applicant to a civil penalty of not more than fivehundred dollars ($500).
Plan Chk. Bal.
O I, as owner of the property, or my employees with wages.as their sole compensation, will.
44
S U0.44
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
CO.nst. "j.
. Professions Code: The Contractor's License Law does not apply to. an owner of property who
00
builds or improves thereon and who does such work himself or through his own employees,34.00
-Mach.
provided that' such improvements are not intended or offered. for, sale. If, however, the building
ti
.or improvement is sold within one year of completion, the owner -builder will have burden
Electrical """y
of proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing 87.50
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. - - ��
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 a exempt under. Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure 1,705491
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. 0 Certified copy is hereby furnished.
. _
r
TOTAL ! -7
CERTIFICATE
CERTIFICATE OF EXEMPTION FROM
-
-REMARKS fir,' -- TP Sf4 1 T0TAL f * 151.2'1
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
NOTICE TO APPLICANT: If, after making this Certificate o/ Exemption you should become '
BY: '
• subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
,ZONE:
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
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 certify that I have this
4 / p
$
read application and state that the above information is correct.
I
Issued by: Date 3 / Nermlt
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. GELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SO. FT. @
CARP. SQ. FT. @
WALL SQ. 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
GH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
AS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REINF. STEEL
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. @ c
BATH TUB
,/
l
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
FIRE ZONE ROOFING
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
GING UNDERGROUND A.C. UNIT
COLL. AREA
SLAB GRADEPI
GH PLUMB.
BONDING HEATING (ROUGH)
STORAGE TANK
FORMS
ot
/
SEWER O S PTI A lr R//OUGH WIRING �� 6 8 ¢��T WORK
ROCK STORAGE
FOUND. REINF. 9
�, /
AS (ROUGH)
1,/
, 7/g, ETER LOOP HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER SERVICE FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.47-
GRADING
FINAL INSP./Z/87 cu. yd.
$ plus x$
_ $
LUMBER GR.
FRAMING10 6
ROOFING � �B B� O�
,/
l
� S
U Fi
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND �Q q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL