0208-121 (RR)Building 36 Arnold Palmer
— a v BUILDING PERMIT PERMITp
U) I hereby affirm under penalty of perjury that I am licensed under provisions of 0208-121
H Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATIONLOT TRACT
C14W Professionals Code,and my License is in full force and effect. $20,418.00
O ch License a Lic.Class Exp.Date
O in 235717 C-39 B MC 1/3]/03 ADDRESS BLDG.36 ARNOLD PALMER APN - -
I- tY
0 Z r- Date Signature of Contractor OWNER CONTRACTOR/DESIGNER/EN 1NEER
OO OWNER-BUILDER DECLARATION PGA.WEST RESIDENTIAL HOMEOWNER'S kSS WESTERN PACIFIC ROOFAIG
—' t J PCS BOX 1060 3462 LA CAWANA WAY
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ N License Law for the following reason: LA Q TA CA 92253 PALM SPRINGS CA 92262
Z ( ) I, as owner of the property, or my employees with wages as their sole (760)416-5877 CBL# 4293
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed GENERAL.BUILDING
contractors to construct the project (Sec. 7044, Business & Professionals
Code). B .3 ; 79-770,79-778,79-786,79.794: RE-ROOF WITH
() I am exempt under Section a&P.C. for this reason POLYURETHANE FOAM &ACRYLIC COATING ROOFING SYSTEM
N Date Signature of Owner
ON
Q WORKER'S COMPENSATION DECLARATION
o if I hereby affirm under penalty of perjury one of the following declarations:Lo VALUATION '10,41$.00 LS
FZ p ( ) 1 have and will maintain a certificate of consent to self-insure for workers'
X W Y: compensation, as provided for by Section 3700 of the Labor Code, for the
Om J Q performance of the work for which this permit is issued.
Q U ( ) 1 have and will maintain workers'compensation insurance,as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
d a Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier STATE FUND Policy No. 0457624-02 ESTIMATED COST OF CONSTRUCTION 20,418.00
PERMIT FEE SUMMARY
g (This section need not be completed if the permit valuation is for$100.00 or less). REROOF FEE 101-000-418-000 $30.00
( ) 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, and agree that if I should become
3 subject to the workers'compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers'Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to$100,000,in
addition to the cost of compensation,damages as provided for in Section 3706
of the Labor Code,interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1.Each person upon whose behalf this application is made&each person at SUB-TOTAL CONSTRUCTION AND PLAN CHECK $30.00
whose request and for whose benefit work is performed under or pursuant to LESS pRE-pgID FEES $0.00
any permit issued as a result of this applicaton agrees to, &shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2.Any permit issued as a result of this application becomes null and void if TOTAL PERMIT FEES DUE NOW $30.00
work is not commenced within 180 days from date of issuance of such
permit,or cessation of work for 180 days will subject permit to cancellation. _
(.certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building 58
construction, and hereby authorize representatives of this City to enter upon IE J
the above-mentioned property for inspection purposes. ---- - - —
RECEIPT DATE BY DATE FINALED INSPECTOR
Signature (Owner/Agent) Date
IIIIIIIII 59
IIII III VIII IIII4
IE 1
P.O. BOX 1504 No. 002700
Building 78-105 CALLE ESTADO
Address 74-77A Axr-mild P lOmer LA QUINTA,CALIFORNIA 92253
Owner
BUILDING: TYPE CONST, OCC.GRP.
Mailing
Address 755 oos oot;wxv ambnrive A.P. Number
CityZip Tel.
palm I • 32260 W-2828 Legal Description
Contractor Project Description I= MOSE 13 B
9 .14=txam wd tand Plea 213 (fit
Address .
r~t. a
City Zip" Tel.
sam
State Lic. City DWG 2
&Classif.2 I30 Lic.# In Sq. Ft. No. No. Dw.
Arch., Engr.,
Size -(M 577 Stories- Units
- -
Designer New OX 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 Businessand Professions Code,and my license is in-fulbfo/rc/e rand,
effect_..-//1,.',0 i-._ \'.1_ )i / /.li It 7Z,
SIGNATURE-+-"' A" ,I' ' .F '7 DATE
OWNER-BUILDER DECLARATION ' .1
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation 161,730.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a - 16 ♦ •13V
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
Me 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 plan Chk. De
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit p
subjects the applicant to a civil penalty of not more than five hundred dollars($500). Plan Chk. BBI. 5i3s i.i
O 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,Bussness and Const. f _f
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 + An
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.)
O I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing 1
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. ' aft
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B.8 P.C.for this reason Grading
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. I
company
❑Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL
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 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, 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 thele 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: Dateit
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 1,j r`y
Mailing Address "`'" 1 Validation:
City, State, Zip
A673 % 11 14 3394, 95 U
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL F' NO. PLUMBING FEES
IST FL. SO.FT.® UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CARP. SO.FT.® DRAINAGE PIPING
WALL SO.FT.
DRINKING FOUNTAIN
SO 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 LAUNDRYTRAY
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
SQ.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®1114 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
STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR
SETBACK OUND PLUM 11'/0.5 6 UNDERGROUND A.C.UNIT COLL.AREA
ALAB GRADE 12 tZeBOUGH PLUMB. Zf7BONDING HEATING(ROUGH) STORAGE TANK
Ift-IleFORMS !a!!/j SEWER OR SEPT S2fA ROUGH WIRINGDUCT WORK ROCK STORAGE
/FOUND.REINF. AS(ROUGH) (�/ �G METER LOOP HEATING(FINAL) OTHER APP./EQUIP.
trJ GREINF.STEEL GAS(FINAL) u TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
r/
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. ,/' l�PINAL INSP. cu.yd.
*01AMING 1�rINAL INSP. ! $ plus x$
00FING Qf�GL 3 e)` 3 ? �iREMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
/r/LATHING
/MESH
INSULATION/SOUND' Si
FINISH GRADING
NAL INSPECTION 9J S�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
-_ ------ - _ _ Page —of—
}
IIIIIIIIIIIIIIIIII so DAVE STEAVENS
--- -- - 1E -- Inspection Services
PROJECT;?Gh1w . i L E. GC.+Ja PROJECT # a cOa7 .O9
ADDRESS 10010,"I'l a 144p."!Q 4 CLIENT t?GfA . ►J S'1"' irk c5 A
i
DATE %Ck Ivo 2
BLDG.PERMIT# ARCHITECT C ,c 3A Rcw
ENGINEER ,d SAJurr f/JL CONTRACTORt Mf1 t1c r r L
INSPECTION TYPE '
INSPECTION REPORT
f,` e' >►a' L S.7 - Sba► rJ i . L t . ji w A . t .,n sr
r,i r' i .ac,•1{ 5' . ' - h'G c X A i r ` Z Y i 1
r L A r
CvM TE <
1
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r
I
i
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CERTIFICATION OF COMPLIANCE:To the best of our knowledge,all of the reported work,unless otherwise noted,
substantiallypomplies with approved plans,specifications and applicable sections of the building codes.This report covers
4eerl4eb work inspected only and does not constitute engineering opinion or project control.
I CERT.NO. ORT f.3 ye - INSPECTOR NAME Ps J t 5*tt A Ua J',
DATE T Tu E o .0 Z
INSPECTOR SIGNATURE:;"_
Page 1 of '
IIIIIIIIIIIIIIIIIIIIIIIII 61 DAVE STEAVENS
IE
Inspection Services
PROJECT Lcoca t) n� PROJECT # c?QQZ -0 9
ADDRESS "��•��0,'���j�8fo'744 CLIENT �P' ar taw 04%
�A&ftA &4Co I PULP �t. � DATE V? -70 J c cPQ v z
BLDG.PERMIT# ARCHITECT Lt3 A A GSI
I ENGINEER,I3 wjJ 4JAJa c Tojt. CONTRACTORJ')CL iPAA- PAC Fr L
' INSPECTION TYPE 4
4
INSPECTION REPORT
I�1 wx 4 A ' nK J40C W,
)r
1
A"4e fit)cop 0
t
I _
I
1
*Dt?A'+•
f
5. 1 - C0.jA C.c•r tj.�s ly�V% WAS L — �d I pt.e-719
-7 -5 (.AiL. JfJA I tf I, A dO j 4.f Ay/S�( t�t fry '• M��L��'G t f
t
�A S -o��b- fti if { _I� 111 .f i,Ad• h r.<�, !�1 r`:�Q �A e�r�t �Ja�L Aoib r?�•`! �
j ` �
r
AJA it_ t!.J[& r�nr� rJL-ICS'
CERTIFICATION OF COMPLIANCE:To the best of our knowledge,all of the reported work, unless otherwise noted,
substantiall oo s with approved plans,specifications and applicable sections of the building codes.This report covers
tawork inspected only and does not constitute engineering opinion or project control.
t 8sP3�
- 5c)
CERT NO. �,! INSPECTOR NAME J S+" j Q.4j
DATE 1-7 j-14 A-j t d?doz•_ •�.��
INSPECTOR SIGNATURE�`. •- •tom
yv �perjury that 1 am licensed 1U
4 BUILDING PERMIT PERMIT# —
I hereby affirm under penalty of perjury that I am licensed under provisions of 0208-121
H Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION Lor TRACT
04 W Professionals Code,and my License is in full force and effect. $20,418.00
O =) M License# Lic.Class Exp.Date
'- d `r' 235717 C-39 B HIC 1/31/03 ADDRESS BLDG.36 A ZNOLD PALA'1ER JOB SITE APN
t; W ^ - -
oZ t-- Date Signature of Contractor OWNER CONTRACTOR/DESIGNER/EN INEER
r- OWNER-BUILDER DECLARATION PGA WEST RESIDENTIAL HOMEOWNER'S kS1c WESTERN PACIFIC ROOFING
PO BOX 1060 3462 IIA CANTANA WAY
W W � I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ N License Law for the following reason: I.A QUINTA CA 92253 PALIv1 SPRINGS CA 92262
Z ( ) I, as owner of the property, or my employees with wages as their sole (760)416-5877 CBL# 4293
compensation,will do the work, and the structure is not intended or offered for
sale(Sec.7044, Business&Professionals Code). USE OF PERMIT
-- 1
I, as owner of the property, am exclusively contracting with licensed GENERAL.BUILDING I IIIIIII VIII III IIIIIIIII
contractors to construct the project (Sec. 7044, Business & Professionals 49
Code). .3 ; 79.770,79.7n,79-786,79.794: RF-ROOF WITH IE
N O I am exempt under Section B&P.C. for this reason POLYURETHANE FOAM &ACRY-LIC COATI'NO ROOFIN0 SYSTEM - _ - --- - —---
O N Date Signature of Owner
0)d Q WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations: 20,418,00 LS
ap
F- ( ) 1 have and will maintain a certificate of consent to self-insure for workers' VALUATION
X W �L compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers'compensation insurance,as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
Il � Z permit is issued. My workers' compensation insurance carrier & policy,no. are:
Carrier STATE FUND Policy No. 0457624-02 E-WIMATED COST OF CONSTRUCTION 20,418.00
n O PERMIT FEE SUMMARY
J (This section need not be completed if the permit valuation is for$100.00 or less). REROOF FEE 101-000-418-000
( ) 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, and agree that if I should become
3 subject to the workers'compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to$100,000,in
addition to the cost of compensation,damages as provided for in Section 3706
of the Labor Code,interest and attorney's fees. .
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1.Each person upon whose behalf this application is made&each person at SUB-TOTAL CONSTRUr-MON AND PLAN CHECK $30.00
whose request and for whose benefit work is performed under or pursuant to LESS PRE-PAID FEES $0.00
any permit issued as a result of this applicaton agrees to, &shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2.Any permit issued as a result of this application becomes null and void if TOTAL PERMIT FEES DUE NOW $30.00
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
1 certify that l have read this application and state that the above information is
' correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
RECEIPT DATE BY DATE FINALED INSPECTOR
Signature (Owner/Agent) Date
IIIIIIIIVIIIIIIVIIIIIII 5044 TW�v
IE P.O. BOX 1504 No. 003062
Buildi6Address 79-770 Arnold, Palmer 78'105 CALLE CALIFORNIAESTAD9
.. LA QUINTA, ORNIA 92253
Owner
Mailing
BUILDING: TYPE CONST. OCC.GRP.-
Address Same A.P. Number PGA Wast
City Zip Tel.
'a Quinta 9225 Legal Description Un8
Contractor 4 H. !?v C4.S Project Description Pool Soa
Sunrise Company
Address
75--8135 Ca' itry Club Drive
City Zip Tela '
Palm Desert 92250
State Lic. City
&Classif. Lic.# C/ Sq. Ft. No. No. Dw.
f
Arch.,Engr., Size Stories Units
'
Designer New, , Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.-#
LICENSED CONTRACTOR'S DECLARATION
is I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section
p 7000)of Division 3 of the Business and Professions Code,and my license is in full force and
effect ♦ r, . ">p •d /
SIGNATURE - DATE
OWNER-BUILDER DECLARATION Estimated Valuation
I 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, 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 BusinessandProfessions Code, or that.he is exempt therefrom, and the basis Plan C.hk. De
for the alleged exemption. Any violation or Section 7031.5 by'any applicant for a permit p
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.
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. m Cy
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 Electrical ^�( _ (f
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
struct-the project..(Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts*for S.M.1. "; •
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) - -
Grading
❑I am exempt under Sec. B.8 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
if�
Worker's Compensation Insurance,or a certcopy,thereof.(Secf3800,Labor`Code.)
Policy No.' Company _ ! 'r!"G•r-
❑Copy is filed with the city. ❑Certified copy is hereby furnished.
TOTAL
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: 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
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.) - —Side Setback from Property Line
Lender's Name
Lender's Address
This is a building FINAL DATE INSPECTOR
permit when properly filled out,signed and validated,and is subject to -INSPECTOR
expiration if work thereunder is suspended for 180 days.
1 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
A7791 4 21 j9L46 it
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SO.FT.® $ UNITS
2ND FL. SQ.FT.
YARD SPKLR SYSTEM
POR. SQ.FT.® MOBILEHOME SVC. BAR SINK
GAR. SQ.FT.® POWER OUTLET ROOF DRAINS
CAR P. Q.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,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. SQ.FT.RESID®11/4 c SEWAGE DISPOSAL
SO.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 EOTHER
SLAB GRADE ROUGH PLUMB. BONDING HEATING(ROUGH) K
FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK E
FOUND.REINF. GAS(ROUGH) METER LOOP HEATING(FINAL) UIP.
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. $-plus-x$_=$
ROOFING REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
I N SU LATIONISOUN D
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
I IIIIIII VIII III VIII IIII 51
IE 44
P.O. BOX 1504 No. 002701
Building 78-105 CALLE ESTADO
Address 79-770 A=XM Pi ]C LA QUINTA,CALIFORNIA 92253
Owner
--- 0=:r I :BUILDINGTYPE CONST. OCC.GRP.
Mailing �'
Address 75-005 C.1b Drive A.P. Number
City Palm DoSartl Zip Tel.
. X92260 .568-28?0 • Legal Description
Contractor Project Description FGA WM PMW 33 B
Nat , yiewbW11111pt and
Address Plan 34 CR
Sam
" City Zip Tel.
State Lic. City
&Classif.2811130 Lic.# 328 Sq. Ft.DW 2825 No. No. Dw.
Arch., Engr:,
Size• ( SISS - Stories Units
-
Designer New Add ❑ Alter ❑ Repair ❑- Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARAT19N_
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. I -
SIGNATURE r r '°�' N DATE _
DOWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following .�, - !��
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
the provisions of 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 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. g2a,in
do the work,and the structure is not intended or offered for sale.(Sec. 7044,•Buisness and Const. �(�
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, McCh.
provided that,such improvements are not intended or offered for sale. If, however, the building cu; - f%
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.) 1111 '71
O 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
O 1 am exempt under Sec. B.&P.C.for this reason
Driveway Enc.
Date Owner Infrastructures
WORKERS'COMPENSATION DECLARATION
I hereby affirm that l 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. O Certified copy is hereby furnished.
TOTAL I /(qR 4h
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 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, 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 state,that the above information is correct. Issued by: _ Date ermlt .
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 ' ' / r '"tel Validation:
City, State, Zip
A6742 11 14 548517 Cti
HARD COPY
i
CONSTRUCTION ESTIMATE NO. ELECTRICAL T:S NO. PLUMBING FEES
1ST FL. SO.FT.® $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT,® I POWER OUTLET ROOF DRAINS
CAR P. SO.FT.
DRAINAGE PIPING
WALL SO.FT.® DRINKING FOUNTAIN
SO.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation I FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD I SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER I GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED I LAUNDRYTRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM. B.T.U. I TEMP USE PERMIT SVC WATER CLOSET'
COMPRESSOR HP I POLE,TEM/PERM LAVATORY
HEATING SYSTEM FORCED GRAVITY I AMPERES SERV ENT SHOWER
BOILER B.T.U. SO.FT.®c BATH TUB
SO.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. I SO.FT.RESID®11/4 c SEWAGE DISPOSAL
SO.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
ETBACK /` _b ,ROUND PLUMBIN UNDERGROUND A.C.UNIT COLL.AREA
SLAB GRADE1.2 062
OUGH PLUMB.Zae 7. BONDING HEATING(ROUGH) STORAGE TANK
FORMS /(SEWER OR SE 0 OUGH WIRINSZ ? DUCT WORK ROCK STORAGE
OUND.REINF. ,.5AS(ROUGH)C/S�F METER LOOP HEATING(FINAL) OTHER APP./EQUIP.
REINF.STEEL GAS(FINAL) G / TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.,
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. 'µFINAL INSP. cu.yd.
4e"FRAMING - FINAL INSP. g ,
I►�.� J $ plus x$ _$
A`ROOFINGnrL� r� C , �/`�� REMARKS:
VENTILATION ! A/l>q l C. J 9
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
946A THING
MESH
n/eiNSULATIONISOUND
Q�✓ FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL