04700 (RPL)ng
Owner
4 4 Qsi
P.O. BOX 1504
Cr�IEg I i r 78;105'CALLE ESTADO
GO—
1-t , 4 Ls LA QUINTA, CALIFORNIA 92253
_ Sunrise Design
ng 75-005 Country Club
2
BUILDING: TYPE CONST. OCC. GRP.
A.P: Number .P A Wast
City Zip J:�68.-2828
.
Palm basest 9,2260
Contractor
63-465 Peres Need
t'hodral C;i Zip 92234
State Lic.
& Classif. 275796
Designer
Address
Lic. N 69
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under.provislons 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. � y,
,SIGNATURE - - DATE
I OWNER -BUILDER DECLARATION
I hereby,affirrn that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5;Business and Professions Code: Any ctfy or county which requires a
Z"1
fo construct, after, Improve, demolish, or repair any structure, prior to Its issuance also
requires the applicant for such permit to Me a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (comenenctng with Section 7000) of
Division 3 of the Business and Professions Code, or that,heis exempt therefrom, and the beefs
for the alleged exemptbm Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a chill penalty of not more than live hundred dollars ($500):
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and' he.structure Is not Intended or offered for sale. (Sec. 7044, Busyness and
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.
provided that such improvements are not intended or offered for sale. If, however, the building
orImprovement is sold within one year of completion, the owner-bufider willhave the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusivelycontracting with licensed contractors to con-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License. Law.)
O, 1 am exempt under Sec. B. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -Insure, or a certificate of
Worker's Compensation, Insurance, or a certifl �` -•py. - ereo1. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumishe&
CERTIFICATE OF EXEMPTION FROM
WORKERS"COMPENSATION INSURANCE
,(This section need not be completed If the permit Is for one hundred dopers (1100) 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
subject to the. Workers' Compensation provisions of the Labor Code, ,you must forthwith
cromp/y with such provisions or this permit,shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby affirm that thereAs.a,construction lending agency for the performance of the
work for which this permltisissued. (Sec. 3097, CtW Code.)
Lenders Name -
Lender's Address
This Is a building permit when properly filled out, signed and validated, and ts:subject to
expiration I.?fwork thereunderis'suspended for 180 days.
I. certify that I haveyrsad this application and state that thecabove information is correct.
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.,
Signature of applicant Date
Mailing Address
City, State, Zlp
Description
t Description Pool G `''pa
eT
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ . Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$20 000
PERMIT
AMOUNT
Plan Chk. Dep.
$
Plan Chk. Bal.
Const.
Mech.
20.00
Electrical
16.00
Plumbing
14.00
S.M.I.
1.44
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
)�`(�� :� 1='�..'. � t]:r �•i:..: r`f"�, •d - ,jv';_.. , 't, til
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback. from Property Line.
FINAL DATE INSPECTOR
10119108
Issued by: Date Permit
Validated by:
Validation:
WHITE - FINANCE, PINK:- APPLICANT, GREEN -: B.UILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
tST FL SO FT h =
UNITS
SLAB GRADE'
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. 6
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEMOME SVC.
BAR SINK
POR SO FT r
GAS (ROUGH)
METER LOOP
GAR SO. FT. It
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP SO FT t
GROUT
WATER HEATER
WALL SO FT M
FINAL INSP.
DRINKINGFOUNTAIN
SO. FT. IV
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION S
=S
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP,
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID'e@ I c
SEWAGE DISPOSAL
SO.FT.GAR a 3Ac
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 GOND. 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:JEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus rS
=S
LUMBER GR.
FINAL INSP,
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
,
GARDEN WALL FINAL