6875 (SFD)Building
Owner
T4ht 4 4 Q"
44-150 Ocotillo
Warinm--Mama Veutu re
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
mailing
Address 42-1500 Gook Street, Suite 135
City Zip Tel.
Palm Desert 1 92.260 1 345-7541
Contractor
Williams
Address
City
State Lic- City
& Classif- 493�Dlq Lic. # 1231
Arch., Engr.,
Designer
Address I Tel.
CityI Zip State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereb affirm that I em licensed under provisions of Chapter 9 (commencing with Section
7000) of �ivision 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
hereby affirm that 1 am exempt from the Conlnactor's License Law for the following
reason: (Sec. 7031, S.Busaress and Professions Coda: Any city or county which reoulre; a
permit to cans&url. after, approve, demofish, or repair any structure, prior to its issuance also
reWdras the appF i for such pemxt to rile a signed sfalemenf that he is licensed pursuant fo
the prairWans of the Contractor's Liconsa Law, Chapter 9 {commenckrp with Section 7000) of
DwWon 3 at the Business and Professrons Code, at that. he is exempt thffndram, and the basis
for the areged examptien. any violation of Socdon 7031.5 by 'any �oplicant fora parmtl
sdrjecf s the to a civil penalty of= more than live hmrdnad dollars {8500},
Li I, as owner of the property, or my empieyees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisress and
Professions Code.- The Corrhaefor's License Law does nor apply to an owner of property who
brdfds or improves thereon and who does such work hknseff or through his own smployeas,
provided that smb impravwnents are not intended or offered for safe. If however, the bnelding
or roprovernom is sold withk7 one year at comWelion, the ownerAxt6der Mil 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 contractors) licensed pursuant to the Contractor'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 certificate of consent to self -insure, or a certificate of
Workers 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 (5100) valuation
or less)
1 certity that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner no as to become subject to the Workers' Compensation
Laws of California.
DatgDate Owner
i< TO APPLlCAf47• Lr, atter making Ihfg CgffflCate of Exemption you should become
s *wJ to the Wwkms' Corrpeusallon W00sfvro of the Labor Cade, you must forthwith
comply wd h such pruirano +s or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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
Lenders Address
This isa 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 1 have read this application and stale that the above information is correct.
I agree to comply wllh all city and county ordinances and state laws Telaling 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
No. 06875
ILDING: TYPE CONST. OCC. GRP.,
Number Tract 24517 -Rancho Ocotillo
Legal Description
Project Description 'Plan 2 "oriel, Lot 2
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $125,428
PERMIT
AMOUNT
Plan Chk. Dep.
$250.00
Plan Chk. Bal.
$
358.53
Const.
730.50
Mech.
-56.50,
Electrical
127-76
Plumbing
1 50.50
S.M.I.
s;2
Grading
Driveway Enc.
Infrastructure
2,822.12
TOTAL
$4,514.71
REMARKS
ZON E: BY:
Minimum Setback Distances:
Fronl Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
1/1.1/90
Issued by: Date_ Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL.
2ND FL.
POR.
GAR.
CAR P.
WALL
ESTIMATED CONSTRUCTION
SO. FT. ® $
UNITS
HEATING (ROUGH)
SQ. FT.
YARD SPKLR SYSTEM
IMOBILEHOME SVC.
SO. FT.
BAR SINK
SO. FT. ® POWER OUTLET
ROOF DRAINS
SQ. FT.
DRAINAGE PIPING
SQ. FT. @
DRINKING FOUNTAIN
SQ. FT.
URINAL
VALUATION $
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
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
J—
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
OUND PLUMBING I UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF. (`�J
GAS (ROUGH) 6 (y�-1 ��L % ^ ETER 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�, b—�a 7'`/
FRAMING f-1 f� _
? FINAL INSP.
ROOFING r
f
/
jJ
'f 00}QQ
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ,p �j L/w �
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SiGNATURESIINITIAkS
GARDEN WALL FINAL