7347 (SFD)T4h
4�wQal
w
Building 44 -!kms, Ucnti 1 to Dr.
Address
Owner
wring --Adams Venture
Mailing
Address 4L -6J0' Conk Street, Suite 335
City Zip Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Palet Desert- 92260 1 345-7541,
Contractor
_ Ni; l 1 i ams Dvve7G rl C- rp. _
Address
Same
City Izip Tel.
State Lic. j City
& Classif. f 9-�9 j 9 li Lic. # 1 j
Arch., Engr.,
Designer
Address I Tel.
CityIZip State
I I
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.
I NATURE DATE
OWNER -BUILDER DECLARATION
1hereby affirm that I am exempt from the Contractors License Law for lite fol{owing
reason: (Sec. 7031.5,8usrness and professions Code: Any city or county whkh regrdres a
perrat to construct, after, improve, dei aksh, of repair arty struclum, prior fa m1s issuance also
requires iiia applicant for such pormr7 to fife a srgned statement that he Is Ucensed pursuant to
M provFslohs of the Contraclor's License Law, Chapter 9 (commencing with Sactdon 7000) of
Division 3 of the Business and Frelessrens Code, or that. he Is exempt Maralmm, and the basis
for the alleged examplion. Any vUafion of Section 7031.5 by any app6canf for a permit
subjects the applicant to a GWI penalty of not more than five hundred dollars fS500).
❑ I, as owner of the property, or my employees wlIh wages as their safe compensation, wlII
do the work, and the structure Is not intended or offered for sale. (Sec. 7044. Buisness and
Prolesslons Code: The Contractors License Law does nor apply to an owner or property who
bullas or approves thereorr and who docs such work himself of through his own empicyees,
provided that such anprovemenfs are not intended or offered fur sate. if, however, the building
ar improvunWrIf is sold wllftin ono year of completion, gee owner•budder w#; have the burden
of proving that he did not build or knprcve far the purpose of sale j
❑ 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 rim, :I;!cly to an owner of property who builds or Improves thereon, and who contracts for
such P• ,Ect• with a contractor(s) licensed pursuant to the Contraclor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificale o1 consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a cortilled 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 the work for which this permit is issued, I shall not
employ any pperson in any manner se as to become subject to the Workers' Compensation
Laws of CaElfomla.
Date Owner
NOTICE TO APPOCANT: 11, after makng this Certificate of Exemption you should become
subject to the Workers' comrpensallon 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. 30D7, 00 Code.j
Lender's Namo
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 Certity 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, Zi
No. 01347
BUILDING: TYPE CONST. OCC. GRP.
A.P. Numbe Tact 24617 - Ranhs) GCol"i :l")
Legal Description
Project Description Plan 34 A, LOt 4
Sq. Ft. No. No. Dw.
Size c: 5'1 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
PERMIT
Plan Chk. Den.
Plan Chk. Bal.
AMOUNT
Const.
Mech.
X. 0
Electrical
?b . W
Plumbing
x t rf
S.M.I.
]�
Grading
Driveway Enc.
Infrastructure
TOTAL
$4,857.92
REMARKS
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
Wij ia0
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES NO.
PLUMBING FEES
1ST FL. SQ. FT. ®
$
UNITS
j
FENCE FINAL
INSP ECTO A'S S IG N ATU R E 511 N IT IA L$
YARD SPKLR SYSTEM
2ND FL. SO. FT.
IMOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
-
---
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
DRAINAGE PIPING
CAR P. SQ. FT.
DRINKING FOUNTAIN
WALL SQ. FT. @
URINAL
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
$
WATER PIPING
NOTE: Not to be used as property tax valuation
,
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL
HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH.FEE
PLCK.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 'f�J Q
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
OR SEPFCg�<�/
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FORMS
EWER
�J
FOUND. REINF_ ` i
�AS (ROUGH)(f // 2�[�a C
/ ((
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
INSP. Gl0!7
LUMBER GR.
FINAL (
cu. yd.
FRAMING A LD
FINAL INSP. %-�5 -Gt
$ Plus
X$ _$
ROOFING? —2 -g a
REMARKS -
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
c G�
MESR
INSULATIONISOUND C
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSP ECTO A'S S IG N ATU R E 511 N IT IA L$
GARDEN WALL FINAL