05016 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54—$25 RivierA LA QUINTA, CALIFORNIA 92253
Mailing
Address 42-600 Cokk Streets Suite 200
City Zip Tel.
Palm Desert 32260 568=2828
Contractor
Hatietael Mortf►cies*
Address
Tela
State Lic. City
& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencingwith Section
7(100) of Division 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031-5,Bushess and Professions Code: Any city or county which requires a
permit to construct, alter, krprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such Penn& to file a signed statement that he is licensed pursuant to
the provisions of the Contractor'; License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the dress and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any vkda ion of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a cavi penally of not more than rive 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, Buisness and
Professions Code. The Contractors License Law does not apply to an owner of property who
builds or irproves Hereon and who does such work himself or through his own employees,
Provided OIct such irproremarts are not intended or offered for sale. If, however, the building
or srprovernent is sold w&Ivh one year of completion, the owner -builder will have the burden
of proving that he did not buil or inprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sea 7044, Busihess 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
such projects wilt; a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sea B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
WorkeY affirm that I have a certificate of consent to self -insure, or a certificate of
pensation 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
WORKED' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
emplq any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
N017CE TO APPLICANT: C, after making this Certificate of Exemption you should become
subject to the Workers' Conversation provisions of the Labor Code, you must forthwith
comply w&h such Pfovsions or Ors Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 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
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.
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, Zop
No. 05016
11LDING: TYPE CONST. OCC: GRP.
P. Number PGA West — Phase 2i£
Description
roject Description Plan P2A
Sq. Ft. 2645 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
S190.002
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. Allso _ sn
Mech. IQ nn
Electrical ng rt
Plumbing AA
S.M.I. ;
Grading
Driveway Enc.
Infrastructure A4 7 . (15 2,137.51
T ^Aa 1*.rftA4P7,132-53
TOTAL q'3_Ai.nn_n1 1 =:'i -,-,.,. !
REMARKS
YJ Pi: i gi 01 1ST
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: Date12`2��8�Permit
Validated
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
B GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
r
2ND FL. SO. FT.
FORMS
ER OR SE T/iNK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT Q
(R UGH)
METER LOOP
GAR. I SO. FT. ®
POWER OUTLET
ROOF DRAINS
T P. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATE;
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
NG Z
/
FLOOR DRAIN
MECHANICAL FEES
DC l
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
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.TU.
SO. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SULATIONISOUND
SO.FT.GAR ® 3/ec
HOUSE SEWER
FINISH GRADING
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
S K
ROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SE T/iNK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REIN F
(R UGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
JTKFINAL)
T P. POLE
GROUT
WATER HEATE;
l
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
Cu. yd -
$ plus x$
=$
LUMBER GR.
FINAL INSP.
NG Z
/
FINAL INSP.
OFING
DC l
S�
%
[ l
REMARKS:
VENTILATION/G`/
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
T N GJ
MESH
SULATIONISOUND
FINISH GRADING
INSPECTION 1 1
6�EL
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL