003345 (BLCK)4,
_ P.O. BOX 1504 No. 003345
Building 78-105 CALLE ESTADO
Address 55-282 Oaf{ Hill LA QUINTA, CALIFORNIA 92253
Owner
Sunrise letliws' ny
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address r s�M+Vr is rItth raw I04wgs _ A.P. Number PGA West
City - - --' Zip - - Tel.
Palm' DeSe � 9Z��S�3 564-76716Legal Description
Contractor Project Description Mick All 15 lies.' ft. X 6' fiiQht
Address
City - JZip Tel.
State Lic. City
& Classif.. Lic. # 328 Sq: Ft. No. No. Dw.
.Size Stories Units
Arch:; Engr., _. ... _ : •
Designer New Ow Add ❑ Alter ❑ Repair ❑ Demolition ❑
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.
SIGNATURE t 'd ?. 4's 1i •'.f: 'rf .•':.+'. .:DATE _ .. .. .
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $4,375.00
reason:. (Sec. 7031.5,Busfness and Professions Code: Any. city or .county which requires a
permit to construct, aflei, improve, demolish, or.repair any.structure; prior...10 its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he'•is'licensed pursuant -to - PERMIT -
the provisions of the Contractor's License Law, Chapter 9 (commencing with 'Section 7000)- of
Division'3 of.the'Business'and Professrons"Code_ or that. he is exempt therefrom, and the basis •.
for the alleged exemption. Any violation of Section 7031.5 - by 'any applicant for a permit. Plan Chk. Dep..
'subjects the applicant to a civil penally of not more than five hundred dollars ($500):
O l,•as owner of the property,, or my employees with wages as'their sole compensation, will Plan Chk. Bal.
do the work., and the structure is not intended of offered, for sale. (Sec. 7044, Buisness and'a. y�Q
Professions Code: The Contractor's License Law does not apply to an owner of property..who. .Cor1St. �6
builds or improves thereon and who does such work himself or through his own employees, McCh. -
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 Electrical -
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- -
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 S. M. 1. - e so
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) .
O I am exempt under Sec. B. 8 P.C: for this reason. Grading
Driveway Enc.
Date Owner Infrastructure
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
O Copy is filed with the city. O Certified copy is hereby. furnished.
TOTAL.Q
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 of 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
Ihereby 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 it 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
REMARKS
sSyi:4�
-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 IR./31i/87 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. O
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. p
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN
SO. FT. ®
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 SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 PLUMBING
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 (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
Insrec 1 UK'b WUNA 1 UKLWI1V11 IALZ,
GARDEN WALL FINAL