04515 (SFD)145. rTUtit'4 Qumz -
'Nz `� P.O. BOX 1504
78-105 CALLE ESTADO
Addrdess : ~' : r -515 Riviera LA QUINTA, CALIFORNIA 92253 �-•
Owner. F „
Sunrise Co813'pc' wy, BUILDING: -TYPE CONST. DCC. GRP.
Mailing
Address 75-005 Country Club Dive + x�7PGA est ,. The. Tai. tads
A.P�Number,
:City Zip Tel. � a :. -. • -
�"a" lm, D086 60 2Legal Description
Contractor .. Project Description Plafi V2A
Add
ress
8 aim..
City
State Lic. 288130.
�. & Classif.'
' Arch., Engr.,-
Designer
Address =
I Tel.
City 398
Lic. N
Tel.
City :?rs +r'. (Zip (State
ji v 1
. a. ..h•n.:t'>�^. LIC.#
}yr LICENSED CONTRACTOR'S DECLARATION ,
I herebyy 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
'•1 hereby affirm that I am exempt from the Contractor's License Law for the following
"reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Sq. Ft. 264 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation $19000HH
PERMIT • AMOUNT "
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 civil penalty of not more than five hundred dollars (5500).
Plan Chk. Bal.
- 536.00
O I, 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
Const.0'
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.
°��- '
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
Electricalo,
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively•contracting with licensed contractors to con-
Plumbing
_
1.14000'
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.I.
13 37
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
_
O I am exempt under Sec. B. 8 P.C. for this reason
,
Driveway Enc.
Date owner
Infrastructure.
$4,275-05
uc aRl. Qre
c 'i.1Y► 2 N 13 7 a Z3
WORKERS' COMPENSATION DECLARATION
Net InIxras Yemv erfr ra ' 2, 137.53
'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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
`
•
TOTAL
*J0but.)oCl
- CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($106) valuation
'
or less.)
1 certify that in the performance of thg work for which this permit is issued, I shall not
�J.
rf°' +'b�- c �t 1 � €'I C� t)a} k+iti
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
. •._
Date Owner
NOTICE- TO • APPLICANT: If, after making this Certificate . of • Exemption you should become
ZONE:
BY:
.subject,to the Workers', Compensation provisions ofthe Labor. Code, you must forthwith
comply with such provisions or this permit shall be deemednmumeac
revoked.
_ _
Distances:
Minimum Setback Dist Y
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. 3os7,' civl coda.)
Side Setback from Property Line
Lender's Name
Lender's-Address'r.';%''-,
This is a building permit when properly filled out, signed and validated, and is subject to
'
FINAL DATE
M
' ¢Ig yfP C
Wi
expiration if work thereunder is suspended for 180 days.
•� '
1 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.
Vdlldated by:
Signature of applicant Date
-
Mailing Address - -
Validation:
_
City, State;, Zip
.
1 -,` WHITE - FINANCE, PINK - APPLICANT, GREEN -- BUILDING,
GOLDENROD -ASSESSOR'S OFFICE,,HARD COPY= FILE• ''.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
tST FL SO FT h $
2ND FL SO FT. C
POR SO FT. at
GAR SO. FT. Or
CAR P. SO FT. re
WALL SO. FT. rd
SO. FT, g
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to Ix: used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
' FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TE P. POLE
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.T.U.
SO. FT. RESID C I'A c
SEWAGE DISPOSAL
SO.FT.GAR @ Y c
HOUSE SEWER
REMARKS:
VENTILATION.
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
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.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL) /
TE P. POLE
GROUT
WATER HEATER
RVICE 41—`CE��'
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION.
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIONS
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL