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04514 (SFD)4 .5.4 P.O. BOX 1504 Building78-105 CALLE ESTADO Address 55-685 Riviera LA QUINTA, CALIFORNIA 92253 Owner . Sunrise Company BUILDING: TYPE CONST. OCC. GRP. Address .75-005 Country Club Drive__ _ 11G,.A, ,We-st The Fatrwaya A.P. Number City Zip Tel. .1. _ Palm DeSta rt 92260 ,568-2828 Legal Description Contractor Project Description Plan F2A National Mortgage Address 8� • City Zip Tel. w State Lic. 288130 City 398 2645 & Classif. Lic. # Sq. Ft. No. No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip 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 DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractoes License law for the following �� reason: (Sec. 7031.5,Business 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 of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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 ($500) ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. `boil) i 01V 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 or property who builds or improves thereon and who does such work himself or through his own employees, Mech. r provided that such improvements are not intended or offered for sale. If, however, the building Ou or Improvement is sold within one year of completion, the owner -builder will have the burden Electrical • 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 114 * QU struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 72 does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. such projects with a contractors) licensed pursuant to the Contractor's License Law.) O I am exempt under Sec. B. & P.C. for this reason Grading Driveway Enc. Date Owner Infrastructure *4 a 275-.05 Laos Credit 2# 14T, t)j WORKERS' COMPENSATION DECLARATION Not Infrastructure :i3 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. TOTALyESi?�13 CERTIFICATE OF EXEMPTION FROM REMARKS ' WORKERS' COMPENSATION INSURANCE #Yct rt+f1 �!l xa ( .c97 t� fid (This section need not be completed if the permit is for one hundred dollars ($100) valuationY rt"7 �.ritt[: 3"�'GYm;IViA J.R or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ any parson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwithMinimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback frcrn Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE I.N PEC/TOR expiration It work thereunder is suspended for 180 days. 6I R I I certify that I have read this application and state that the above information is correct. Issued by: Date Permit I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above. mentioned property for inspection purposes. Validated by: SI$nature of applicant Date Malling 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 ISI FL SO FT y $ 2ND FL SQ FT. C POR SO FT. at GAR SO. FT. C1 CAR P. SO FT. a WALL SO. FT. (d SO. FT. (& 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 be used as property tax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER GAS (ROUGH) / GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT. B.T.U. SO. FT. RESID @ I'A c SEWAGE DISPOSAL SO.FT.GAR gr Vic HOUSE SEWER REMARKS: 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./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER RVICEi2 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 NAL INSPECTION IV CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL