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P.O. BOX 1504 No.
Building' 71-245 ia02; a Vista 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Mr. & Mrs. S. I. Dorn
Address
City Zip . Tel..
Legal Description LUt '24' 1' 'cac 25237
Project Description
'Palm Desert, C A 92261 346-•8071
State Lic. v. City
& Classif. Lic. #6
-Arch., Engr., ~~ w
Designer Habitat
• A dres ,'r; Tel. i' `
8- O 6 Vista Ciel ,68 36 `A
City Zip State
La QlY fltaV.
CA 92253 Lic. #
LICENSED 664TRiCT, RIS sEC AATION i
I hereby affix that I am licensed' intler Droy sioh ofaater 9 (commencing with Section
7000) of Dwlsion8,ro[f.the Businessland PFofessiofi Codddddde; h my license is in ful ,fo rc%d
affa.'rf Yl. t/L6✓,e i 1b ,,p, ✓ R
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec.-7031.5,Business and,Professions Code: Any city oricounty which requires a
permit 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
the provisions of "the Contractor's License Law, Chapter 9. (commencing with Section 7000) of
Dfvision 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for thealleged exemption. Any; violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure -is notintended 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.)
O 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)..
Policy No. Company
❑ Copy is filed with the city. _O Certified copy is hereby furnished. S
i` • CERTIFICATE OF EXEMPTION FROM
`4ORKERS' COMPENSATION INSURANCE
(This'section need. not be' 65h;pleted 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 or 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
Sq. Ft.
Size
New ❑
fy..
S fir ^ '.No.'
4
'-Stories
Add ❑ Alter ❑
yer3it in^1:
block
No. Dw.
Units
Repair ❑ Demolition ❑
does ,160 3. f . of 6'
iia 11.
i..
:stimated Valuation ,
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
COr1St. • -
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
395.,350.00
Arts in Puoii : F:aces
TOTAL 10,586
REMARKS
1,129.73
1#6720,00
19 8 .00
i. 288.50
-3 '4
89.5
20.00
.00
6,000.00..
738.38-
1\
i r
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 •, Permit
Validated by: ' -
t Validation: -
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
—
2ND FL. SO. FT. @
FORMS
YARD SPKLR SYSTEM'
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
f
DRAINAGE PIPING
WALL S0. FT.
WATER HEATER SERVICE
DRINKING FOUNTAIN
SQ. FT. ®
BOND BEAM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
LUMBER GR.
WATER PIPING
NOTE: Not to be used as property tax valuation
- ✓P ( L -P v n.-S v/
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3 a
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
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
LATHING+01VA/
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
SO. 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
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 R rrS 6 —3
OUND PLUMBING 5-4-W 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/fhi0 ✓OH METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) 5 TEMP. POLE
f
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.ig
FINAL INSP. /
GRADING
cu. yd.
$ plus x$ _$
LUMBER GR.
FRAMING
ROOFING . Lr 'Gf ,b
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3 a
1 L Z (?
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! 7
REMARKS:
VENTILATION
u—
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING+01VA/
MESH
SULATION/SOUND - I L
FINISH GRADING
I
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL