04763 (SFD)40 4u�G!Cu
4763
P.O. BOX 1504
Building55-245 �V$a 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing Sunrise Company BUILDING: TYPE CONST. OCC. GRP.
Address 75-005 country Club A.P. Number PGA West Phase 2FD
CityZip Tel.
Palm Desert 53260 1 Legal Description
Contractor Project Description Plan F3A
National Nord age
Address
Satan
City Zip Tel.
State Lic. 288230 City 39e038
& Classif. Lic. # - Sq. Ft. �. No.. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. If
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 DATE
OWNER -BUILDER DECLARATION Estimated Valuation$2171,204
f g1 e7 i� A
I hereby affirm that I am exempt from the Contractor's License Law for the following 21 �I 1, 204
reason: (Sec. 7031.5,Susiness and Professions 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 applicant for such permit to file a signed statement that he Is licensed pursuant to PERMIT AMOUNT
the provisions o/ 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 o/ Section 7031.5 by any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500). D
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. O •
26
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. ��,8 Qp
Professions Code: The Contractor's 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.39.00
A A
provided that such improvements are not intended or offered for sale. If, however, the building 3 7 • L A V
or improvement is sold within one year of completion, the owner -builder will have the burdenElectrical 109.94
of proving that he did not build or improve for the purpose o/ sale.) •
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 118.00
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 /or S.M.I. 15.26
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure .Q • • Q If 414.1 • yJ
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS r r
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 1/ the permit is for one hundred dollars ($100) valuation •i:�'�irs�f�.r%S '►�01'£i-' r `"i�ii141.. 1
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
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE IIN�SR C 12 O�,R�
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
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE,
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (p S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
POR SO FT. a
MOBILEHOME SVC.
BAR SINK
GAR SO. FT. rlr
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEOUIP.
DRAINAGE PIPING
CAR P. I SO FT. ad
I
WALL SO. FT. Q
lo
GROUT
DRINKING FOUNTAIN '
SO. FT. C
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
.S
FLOOR DRAIN
- MECHANICAL FEES
FINAL INSP.
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
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 g t V: c
SEWAGE DISPOSAL
SO.FT.GAR @ JAc
HOUSE SEWER
INSULATIONISOUND
GAS PIPING
PERMIT FEE
F NISH GRADING
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGH) �-3�e2
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL10
(FINAL)
TEMP. POLE
lo
GROUT
WATER HEATER
ERVICE,,��
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus xS
.S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
F NISH GRADING
FINAL INSPECTIO t
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL 7d