003189 (SATT)W 4
it Q911AM
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55-021 Oak x.1.3. LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-05 CC=tr7 Club Drive
City ZipTel.
Pada Desert . 92260 368-2828
Contractor
Address
�'36B
ty.. jZip -
State Lic. I City
& Class !f.. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
City Zip State
- 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. 7
SIGNATURE DATE
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 or county 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 licensedpursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of -the'Business and Professions Code, or that. he is"eiempt therefioin, and the basis
for the alleged 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 ($500).
❑ I, as owner of the.property, or my employees with wages as their sole: compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does -not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such, improvements are not intended or offered for sale. If, however, the building ;
or improvement is sold within one year of completion, the owner -builder willhave the burden
.of proving that he did not.build or improve for the purpose of sale.) '
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Coder The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
.❑ 1 am exempt under Sec.. B.•& P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company
❑ Copy is filed with the city.. ❑ Certified.copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is :for one hundred dollars ($ 100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any 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
HARD COPY
No. 003189
BUILDING: -TYPE CONST. ' OCC: GRP.
A.P. Number PGA West
Legal Description
Project Description ��� 30-6, Plan 1
Building 2
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft. D -T' 133()
Size '424
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: -
Date AhFA.7 Permit
Validated by:
Estimated Valuation
$96,244-900
PERMIT',
AMOUNT
Plan Chk.. Dep.
Plan Chk. Bal.
f► [aa�
Const.
Mech. '
1tt;-aft
Electrical
A ��
Plumbing
A7 s;:y
S.M.I.
A A
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
FYP"9�wM CtilTAC i
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 AhFA.7 Permit
Validated by:
Validation:
a� CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
ROUGH PLUMB. NDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. p
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SQ FT ®
GAS (FINAL) TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
��
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ®1+/a c
b
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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 PLUM IN O - UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. NDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. �J
GAS (ROUGH) /O// 04, &METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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.
FINAL
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 SIGNATURESIINITIALS•
GARDEN WALL FINAL
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