04610 (BLCK)Building 04-761
Address
u
P.O. BOX 1504
Cherry Hills., LA QUINTA CALIFORNIA 92253
sunriao Desert Partnor
7.5-005 Country Club 1.3r- ,
City Zip � Tel. .:.
�aLn Decor 9226A 568-9820
National Mortgacre t�
ress Same
State Ljc:City
1£ Classif. 2 M 130 Lic. # 32
Arch., Engr.,
Designer
Address Tel.
City( Zip I
State.
Lic. #
.LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I,am licensed. under provisions of Chapter 9 (commencing with Section
7000) of Divlslon 3 of, -the Business and'P,!O as one Cade, .and mY license le In full'for�e and
r1 '-. 1 t� d,+° 4
SIGNATl1RE /.!� �•f: i�..1. 1� ;._s3 J DATE
OWNER -BUILDER DECLARATION
1 hereby affirm that.'( am exempt from the Contractors License law for the following
reason: (Sec. 7031; 5,Susiness and Professions Code: Any city or county which requires a
penMt to constmct: after; -h iprove, demolish, or repair any structure. prior to Its Issuance also
requires the eppllcanl'for^s_rgh,penn8 to Mea ed'statement that he Is aconsed pursuant to
the P
rovisions of the: Contraclor's'License Law, Chapter 8 (commencing with Section 7000) of
Division 3 of the Business and` Protessons Code, or that he, Is exempt therefrom, and the basis
for the ===Any =Any violation of Section 7031-.5 by any applicant for a permit
subjects: the eppAcent to a cM/ penalty of not more Man live hundred doffm ($500).
O I, as owner of the property, or my, employees with'wages.ae their.sole compensation, will
do the work, and the structure is not Intended or offered for sale. (Sec. 7041, Sulsnsss and
Professions Code: The Contractor's License Law does not apply to an owner of property who
bunds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for safe. ft, .however, Me building
orMmprovement Is sold within one year of cortpletion. Me owner-bubder will have Me burden
Of provMg that he did not build or improve for purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec.. 7044, Business and Professions Code: The Contractor's Ucenee Law
does not .apply town owner of, property who builds or improves Merecn.and who contracts for
such projects wrM a contractor(s) licensed pursuant to Me Contractor's License Lew)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have.- certificate of consent to, self -insure, or a certificate of
Workers. Compensation Insurance, ora certified' t efeof. Sec. 3800, labor Code.)
Policy No Company el �f5 ' 1
❑ Copy is filed with the city. ❑ Certified'bopy,ip_hereCy furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This seclron need not be completed If Me permit Is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of the 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: ti, after making this CerMicate of Exemption you should become
subject to the ftrlere' Compensation provisions of Me. Labor Code, you must fomQmwlM
comply with such provisions or this permit seai/ bedeemed revoked.
CONSTRUCTION'LENDING AGENCY
I ereby halfirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, ChM Code.)'
Lenders Name
Lenders Address
This. is a building permit when properly filled out, signed and validated, and'is subjectto .
expiration If work thereunder is suspended'for 160 days.
1 certify that't have read this application and state that the above Information is correct.
I agree to Comply with all city and county ordinances and state laws relating to building
construction, and .hereby authorize representatives sof, this city to enter the above-
nlentioned property for inspection purposes.
Signature of applicant Date
Melling Address
City; state, Zip
eu )
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number PGA Vest — Phrase 11-B
Legal Description
Project Description 1204 11F block wall. a
wrcmght iron fence
Sq. Ft.
`Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$3000)
PERMIT
AMOUNT
Plan Chk. Dep.
$125.9,5
Plan Chk. Bal.
193 a 40
Const.
Mech.
Electrical
Plumbing
S.M.I.
? . 07
Grading
Driveway Enc.
Infrastructure
TOTAL
F,, '• -. . ,�'
REMARKS
"A;J
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 ANSPECTOR
Issued by: Date r / 6 / 13 8 Permit
Validated by:
Validation:
WHITE -FINANCE, PINK :APPLICANT, GREEN:- B�ILpIMOi OOtAENNOO - �68Eitii0il'S .OFFICfE, HARD COPY,,. FILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO FT ar f
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR.SYSTEM
2ND'FL 80 FT.B
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOMESVC.
BAR SINK
POR SO FT a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR 50. FT. M
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP SO FT 6
FINAL INSP.
WALL SO. FT. a
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
= pius xf
=f
URINAL
SO: FT. 6
FINAL INSP,
FRAMING
ESTIMATED CONSTRUCTION VALUATION f
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(AUTONDISHI
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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.
SO. FT. RESID C IV. a
SEWAGE DISPOSAL
SO.FT.GAR @ 4%c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL:FEES
MICRO FEE
MECH.FEE k_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./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
= pius xf
=f
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 SIGNATURESIINRIALS
GARDEN WALL FINAL 71