06157 (SATT)4
P.O. BOX 1504 No. 06157
Building 55-531 Oak M1178-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing
$u=is8 Company BUILDING: TYPE CONST. OCC: GRP.
Address 42-600 Cook Streee, cSulte 200 A.P. Number PGA West
CityZip Tel.
Pas. i Desert: 192260 1 Legal Description
Contractor flatiouaI varigage Land Project Description Tract 20717-1Medalists
&
Address Platt 3U3
si M
City Zip Tela
State Lic. City
& Classif. 238130 Lic. # 398, Sq. Ft.. 2.223 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I heieby affirm that I am licensed under+provisions of Chapter 9,(commencing with Section
7000) of Division 3 of the Business and Professions Code, and Ymy license- is in full force and
.. .;effect -z 1 ...:,--- r�:..✓!'_✓'s
SIGNATURE DATE
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt fromthe Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031.5,Business and Profession's 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 apprcani for such permit to me a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions or the Contractor's 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 alleged exemption- Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a crvit penally of riot more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Suisness and Const- bl�iz•OU
Professions Code: The Conhactoes License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees, Mech. •t
provided that such improvements are not Intended or offered for sale- If, however, the building
ri
or Improvement is said within one year of completion, the owner -builder will have the burden Electrical u:� •(a /
or proving that he did not build or iniprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing•
struct -the project. (Sec- 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or Improves thereon, and who contracts for S -M-1- s2$�
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec_ R- 8: P.C. for this reason
Driveway Enc.
Date owner Infrastructure a�O slj3•ztt3
be isa lireia: t t,733.4v
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.
TOTAL ` 7 d ` Q/
CERTIFICATE OF EXEMPTION FROM REMARKS Y.,-.rn rv:... -<,,
WORKERS' COMPENSATION INSURANCE .. t.r: _..<..- .
(This section need not be con%%Wed ff the permit is for one hundred dollars ($100) valuation 4Sf '�'S. '-•. :z.>K.s:� �,-r w'
or less-)
I certify that in the performance of tt 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: ff, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Canperisaffon provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shag be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued- (Sec. 3097, CIO Code-) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INS CTOR
This is a building permit when property filled out, signed and validated, and is subject to NS C'
9
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. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
B GRADE
GH PL
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
E OR SEPTI
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
OUGH) /L
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
=$
LUMBER GR.
FINAL INSP.
GAMING
URINAL
SQ. FT.
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AIJTOXDISH)
APPLIANCE DRYER
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Yic
HOUSE SEWER
FENCE FINAL
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
I&ROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL AREA
B GRADE
GH PL
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
E OR SEPTI
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
2&U -ND. REINF.
OUGH) /L
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
r GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
ICE (
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
GAMING
FINAL INSP. -
ROOFING 'l
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
SULATION/SOUND �Qg
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1