06161 (SFD)4
P.O. BOX 1504 N o . 06161
Building 78-105 CALLE ESTADO 7
Address 55-499 Oak Hill LA QUINTA, CALIFORNIA 92253 n ,r j; %� 14- �— ( S / S
Owner
�'�
Mailing sunrise ComFauv BUILDING: TYPE CONST. OCC: GRP.
Address 42 -600 -Cook St., Shite 200M West
A.P. Number
City Zip Tel.
Palm Desert 92260 Legal Description
Contractor Project Description Tract 20717--1 — Medalists
Hatio al Mortgage to Land
Address
City lZip I Tela
State Ljc. 288130 I Licy
8 Classif. # 298
Arch., Engr.,
Designer
Address Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000)'of. Division 3 of the Business and Professions Code, and my''lice�nssee is in fullforce and
•.ef�ect:
SIGNATURE /" s' DATE
OWNER4WILDER DECLARATION '
I hereby affirin that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8vsiress and Pralesslos Code: Any city or county which requires a
permit to constrict, alter, improve, demolsh, or repair any structure, prior to its issuance also
requires the applicant for such pemml to fie a signed statement that he is licensed pursuant to
the provisions of the Contractors License law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the agaged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenaly of Trot more than fire 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 Contactors License Law does not apply to an owner of property who
builds or inproves 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 wdfm one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ 1, 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 properly who builds or improves thereon, and who contacts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec a_ & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I her 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 it the pemo is for one hundred dollars (5100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of
Cali
omnia
Date Owner
NOTICE TO APPLICANT: N, after making anis Certificate of Exemption you should become
subject to the Workers' Compensation provsiors of the Labor Code, you must forthwith
comply with such provisions or this Pemrlt 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I car ity that 1 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 ❑
Plan 3uAR
2129 No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
(Estimated Valuation $154,080
PERMIT
BY:
AMOUNT
Plan Chk. Dep.
Front Setback from Center Line
Plan Chk. Bal.
666.42
Const.
Side Setback from Property Line
832-.00
Mech.
NS Ai TOR
60.00
Electrical
Issued by:
105.67
Plumbing
11120.50
S.M.I.
Grading
Driveway Enc.
Infrastructure
$3,466.80
1.7333.40
Ti,epon &
731.4n
TOTAL
�5 .
rJ <J L_ 7-/.
REMARKSnr>
ani s,r,.aR,06.C�!?_-3�3_!'_[t.,_.
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
NS Ai TOR
t Ii II
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING.FEES
1ST FL. SO. FT. ® $
UNITS
GRADE
4052
UG
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
/
R SEPTI k
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
(ROUGH)' /)
C/
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
11
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SO. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ -Plus-X$-=$
URINAL
SO FT ®
MING cv
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
D'k
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
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 I
IBATH TUB
SULATION/SOUND
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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
ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
GRADE
4052
UG
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
/
R SEPTI k
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
ND. REINF.
(ROUGH)' /)
C/
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
11
GROUT
WATER HEATER
VICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
MING cv
FINAL INSP.
ROOFING G
D'k
REMARKS:
VENTILATION
FIRE ZONE ROOFING,
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
SULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
1