06334 (SATT)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54-835 Riviera LA.QUINTA, CALIFORNIA 92253
Sunrise Compauy
Mailing
Address 75-005 Country Cub
City 1z'P92260
Tel.
�:l-a Desert 568-2825
ress
el:
State Lic. I City
& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address I 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 and
effect-
SIGNATURE
ffectSIGNATURE - �^'./'' / f DATE
r OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason-, (Sec. 7031.5,13ursmess and Professions Code: Any city or county which requires a
permit to construct. alter, improve. den-Ush. or repair any structure, prior to ft issuance also
requires the appfeant for such Permit to file a signed statement that hes dcensed pursuant to
the provisions of the Contractor'; License Law, Chapter 9 (conmrencirg 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 appGpnt to a civil perwRy of not more than five hundred doom f$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, Busness and
Professions Code. The Contractors License Law does not apply to an owner of pmperty who
builds or improves thereon and who does such work hinseff or through his own employees,
Provided that such improve encs are not intended or offered for sale. 8, however, the budding
or improvement is said within one year of completion, the owner -budder wig have the burden
of proving that he thud not build or improve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec- 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon, and who oedracts for
such -projects with a contractar fs) licensed pursuant to the Contractors License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
WORKERS'COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 380M Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the Permit is for one hundred dollars (5100) 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 Wo kers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT : d after making this Certificate or Exemption you should become
suNect to the Workers' Compensation provisions of the Labor Code. you must forthwith
comply with such provers or this peed 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, Chd 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 certity 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
1-3
No. 06334
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number i A €,last s' Phase 3€ B
Legal Description
Project Description Tract 24:317-1a Plan IW
Sq. Ft. 2232 « No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $158,646
PERMIT
BY:
AMOUNT
Plan Chk. Dep.
Front Setback from Center Line
Plan Chk. Bal.
704.27
Const.
Side Setback from Property Line
846.00
Mech.
Iff tt SRYCCTTOR
82.510
Electrical
Validated by:
A23.02
Plumbing
Validation:
192.00
S.M.I.
11.13
Grading
Driveway Enc.
Infrastructure
3 g.3
1,784.77
LessMUTL
A a 04**
TOTAL
REMARKS
ren s e A
rA'AI3 Art.:
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
Iff tt SRYCCTTOR
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
LAB GRADE l� Z
2ND FL SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
F. U
GAS (ROUGH)_j.-Vj - 07v
DRAINAGE PIPING
CAR P. SO. FT.
OTHER APPJEQUIP.
E / . STE
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
�/ T-"' 1 — 2L-6�U
/
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION/(�
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
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Lc
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE fL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SBACK
OUND PLUMBING4 i
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE l� Z
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS7
SEWER OR SEPT Kf
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
F. U
GAS (ROUGH)_j.-Vj - 07v
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
E / . STE
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.,*j
RAMING—1 /�
FINAL INSP.
OOFING /��C�'
�/ T-"' 1 — 2L-6�U
/
REMARKS:
VENTILATION/(�
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING 2^ 4 v
MESH
4&/(JNSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL