06156 (SATT)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55-539 teak Hfii LA GUINTA, CALIFORNIA 92253
Owner
Mailing
Address 42-500 Cook Streets Suite 200
City Zip Tel.
Palm Dessert 92260 1 - .
Contractor
Address
ional.. MortRat?e & Land
ITel.: —
State Lic. I City
& Classif. 288130 Lic. # 298.
Arch., Engr.,
Designer
Address Tel.
CityI Zip I 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.a_nnd
effect fv M" F'�.�w..-r`S ' •7`"" _�'fR ). :.r. � if �� % `� ��'I �.(
SIGNATURE I i DATE
OWNER BUILDER DECLARATION I
1 hereby affirm that I am exempt from the Contracto's*License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county whichrequires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signedstatement that he is licensed pursuant to
the provisions of 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
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 not intended or offered for sale. (Sec. 7044, Bussness and
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or onproves thereon and who does such work himself or through his own employees,
provided that suchorrprovements are not intended or offered for safe. ff, however, the building
or improvement is sold within one year of corriplelion, the owner -builder wig have the burden
of proving dud 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, Bus -mess and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractors License Law.)
❑ I 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
Workers Compensation Insurance; or a certified copy thereof. (Sec. 3800, tabor 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 ff 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
N017CE TO APPLICANT: ff, after making this Certffrcate 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 shaft 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, Civif Code.)
Lenders Name
Lenders 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 certity that I have read this application and state that the above information is correct.
1 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
No. 05355
BUILDING:- TYPE CONST. OCC: GRP.
A.P. Number PGA WEST
Legal Description
Project Description. Tract'i0717-1 .. Medalists
,Sq. Ft. 5j5 No. No. Dw.
Size Stories Units
New ❑ Add.❑ Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
$111.714
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
554-22
Const.
• 5u
Mech.
.tit
Electrical
Plumbing
12D.5
S.M.I.
.134
Grading
Driveway Enc.
Infrastructure
$2,513.57
1,25b.7-9
Less Credit
1,256-79
TOTAL
REMARKS
iMtrt'ir.il.Hi'n�c;f�.a.".;i-dsb i `Fa f.: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 DATEINSPECTOR
Issued by: Date Permit
Validated by:
Validation:
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FFFS
1ST FL. SQ. FT. ® $
UNITS
•
H PL BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
qfj#ER OR SEPTIFir ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SQ FT ®
(ROUGH) j METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GAS (FINAL) TEM . POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. ®
FINAL INSP.
WALL SQ. FT.
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SO FT ®
/
AMING /O /
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
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(AUTO)(DISH)
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.
SQ. FT. ® c
BATH TUB
LATION/SOUND
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE tL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
UND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
H PL BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
qfj#ER OR SEPTIFir ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF. fa V
J
(ROUGH) j METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL) TEM . POLE
GROUT
WATER HEATER ERVICE �( C�
FINAL INSP.
BOND BEAM
WATER SYSTEM 77 17
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
/
AMING /O /
FINAL INSP.
OOFING
O�j d'.)
!�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
LATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL