002705 (SFD)79738 Arnold Palmer
r IIIIIIIIIIIIIIIIIIIIIIIII 794
IE
P.O. BOX 1504 No. 002705
Building 79-? IA Pa171r LA QUINTA,CAL FORNIA 92253
Address (
Owner
swlrjAm BUILDING: TYPE CONST. OCC:GRP..
Mailing
Address 7-5-005 tvmtxv Club Prive A.P. Number
City Zip Tel.
Palmie 9 0 .569-M Legal Description
Contractor Project Description UM 13 R
PIM 40 OR _
Address.
..City Zip - Tela "
State Lic. City MM 3142
&Classif. 13o. Lic.# 328Sq. Ft. No. No. Dw.
-
Arch., Engr., Size 589 . . Stories -• Units
.. . - ... .. _ .. ..
Designer New R Add ❑ Alter 0 -. Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARATION r
I hereby affirm th arpdi6ensetl,under provisions of Chapter 9(commencing with Section
7000)of Divisiori 3 of.the Business and Professions.Code,and my license is in full force and"'
effect. - /; uS—:F /R < is s ZW" '
SIGNATURES•+ .b' -ted - O - f DATE - -
,, OWHER•BUILDER DECLARATION
Estimated Valuation
I-hereby affirm that I am'exempt from the Contractor's License Law for the following '1972349.00
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) of '
"Division-3 of the Business and Professions Code, of that.he is exempt therefrom, and the basis -
for the alleged exemption. Any violation of Section. 7031.5 by:any applicant for permit. 'Plan Chk. Dep.
'subjects the applicant to a civil penalty of not more than live hundred dollars($500). : - . Gt
Plan Chk. Bal..
❑I,as owner of the,property,or my employees with wages as their sole compensation,will 5i35t•Zg
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. 678.00
Professions Code: The Contractor's License Law does not apply to an owner of-property who
builds or lrrrproves 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
Electrjcal '
of proving that he did not build or improve for the purpose of sale.) A *
❑ I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing
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. `
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
Grading
❑I am exempt.under Sec..B.B.&P.C.-for this reason -
Driveway Enc.
Date owner ' Infrastructure 2.000.00
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 . A Z
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE.
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) _
I certify that in the performance of thg 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, after making this Certificate of Exemption'you should become ZONE:
roBY:-
subject to the Workers' Compensation pvisions of the Labor Code, you must forthwith :Minimum SetbackblS{anceS: -
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
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 FINAL DATE, INSPECTOR
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.certify that I have read this application and state that the above information is correct. - Issued by: Date. 11Fi13°- ermit
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 r
A6729 11 14 3 5 8 U 1 7 Ck
HARD COPY
Amok
CONSTRUCTION ESTIMATE NO. ELECTRICAL cS NO. PLUMBING FEES
1ST FL. SQ.FT.® $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SQ.FT.® MOBILEHOME SVC. BAR SINK
GAR. SQ,FT.® POWER OUTLET ROOF DRAINS
CAR P. I SQ.FT.® DRAINAGE PIPING
WALL SQ.FT.
DRINKING FOUNTAIN
SQ.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET'
COMPRESSOR HP POLE,TEM/PERM LAVATORY
HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT.®c BATH TUB
SQ.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SQ.FT.RESID®11/4 c SEWAGE DISPOSAL
SO.FT.GAR®3/4c HOUSE SEWER
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
nn STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR
SETBACK `/ ROUND PLUMBINCI UNDERGROUND A.C.UNIT COLL.AREA
DG SLAB GRADEj2_'22iOUGH PLUMB. ' BONDING HEATING(ROUGH) STORAGE TANK
FORMS &OEWER OR SEPTI T N el4rAUGH WIRING_f/G t^ DUCT WORK ROCK STORAGE
FOUND.REINF. 41tIPAS(ROUGH) METER LOOP d HEATING(FINAL) OTHER APPJEQUIP.
REINF.STEEL GAS(FINAL) / TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP./,-' l ,
BOND BEAM WATER SYSTEM J
GRADING
LUMBER GR. r4/,Z FINAL INSP. / j cu.yd.
ILI71
RAMING / FINAL INSP.L / yyn/ $ plus x$ _$
'((j(C _ROOFING r iTl 7 1 NT rT T 12 ! S K uG REMARKS:
_ROOFING
66` 'VENTILATION < Ale -TO L'i K'A,n 9(./C
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL '1
&/1 THING 3 2
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL
80
4
IE A' j
P.O. BOX 1504 No. 003305
Building 78-105 CALLE ESTADO
Address 79-738 AMNOLD PA12M LA QUINTA,CALIFORNIA 92253
Owner
Int. A las, KA00.14 JONES
BUILDING: TYPE CONST. OCC.GRP.
Mailing
Address A.P. Number
City Zip Tel.
TA QR7CNIA. 92253 Legal Description
Contractor Project Description rMNIT TO CO3]ST UCT PWL & SPA,
STEVE DWSON
Address PE. MOM PLAN
68-703 P=Z ROAD, STNS. A25
• City Zip Tel.-
C,AT RAL CITY 92234
State Lic. City
&Classif. 45.5607 Lic.# f r <i' Sq. Ft. No. No. Dw.
Size Stories • Units
Arch., Engr., -
Designer New;1111 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
,1 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under prdvisions of( pte 9(commencing with Section
70 OO)of Division 3 of the Business and tProfessions Code,,and.my license is in full force and
effect.
_SIGNATURE •+ w - -"' ' `' "" ', - t'i. DATE
OWNER-BUILDER DECLARATION ` "' Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following - ty
reason: (Sec. 703 1..5,Business and Professions Code: Any city or county which requires a V
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, Chapter9 (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 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). "
O I,as owner of the.property,or my employees with wages as their sole compensation,will Plan Chk. Bal. 7 w
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. j 511Professions Code: The Contractor's License Law does not apply to an owner of property who G
builds or improves thereon and who does such work himself or through his own employees, Mech. 3D },,
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 Electrical - 20.00
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 14.00
struct the project. (Sec. 7044,.Business and Professions Code: The Contractor's License Law -. t
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 1.09
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt.under Sec. B.&P.C.for this reason
Driveway Enc.
Date owner Infrastructure
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
0 Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL 243.31
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE ".
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of tha 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, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of 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
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 FINAL DATE INSPECTOR
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 certify that I have read this application and stale that the above information is correct. Issued by: Date R1 If)JR7 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
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL. SQ.FT.® $ UNITS
2ND FL. SQ.FT.
YARD SPKLR SYSTEM r
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. SQ.FT.
DRAINAGE PIPING
WALL SQ.FT.
DRINKING FOUNTAIN
SQ.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET'
COMPRESSOR HP POLE,TEM/PERM 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. SQ.FT.RESID®11/4 c SEWAGE DISPOSAL
SQ.FT.GAR®3/ac HOUSE SEWER
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 APPJEOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP.
cu.yd.
FRAMING FINAL INSP. $ plus x$ _$
ROOFINGIG-�-�7 REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL