003641 (SATT)ce . 0
4
P.O. BOX 1504
Building78-105 CALLE ESTADO
Address 55-873 Congressional. LA QUINTA, CALIFORNIA 92253.
Owner
Sunrise Camnany
No.
003641
BUILDING: TYPE CONST. OCC: GRP:
Mailing,
Address. 75-005 Coantry Club Dtvb.e A.P.,N_ umber PG West
City Zip Tel.
Legal Description
Paul* Deman 92260 568--2828' . .
Contractor Project Description Phase 5A. Flan .31MR
NatibnAil' Mortgage 4 (band
Address
State Lic.
& Classif. 288130
Arch., Engr.,
Designer
Address
ELM
Tel.
32a. e . - _ Sq. Ft. DTIG 3054 No.
Size Stories
New ❑ Add ❑ Alter ❑
City Zip State
Lic.-#
LICENSED CONTRACTOR'S DECLARATION f`
I hereby affirm that'l am licensed under provisions of Chapter 9 (commencing with'Section
1000) of Division 31bf the Busifiess and Professions Code, and my license is in full force and
effect...-
�.''
SIGNATURE DATE
OWNER -BUILDER DECLARATION
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
Estimated Valuation
.$2-13,r 133
No. Dw.
Units
Repair ❑ Demolition ❑
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to'lile a signed statement that he is licensed. pursuant to
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
subjects the applicant to -a civil penalty of not more than live hundred dollars ($500):
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
PERMIT
- AMOUNT
- c
Plan Chk. Dep.•.
'
-
Plan Chk. Bal.
c; c:pa?) _.
Const.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who,
.Mach. -
' nsfin .
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.
Electrical
Z Q
or improvement is sold within one year of completion, the owner -builder will have the burden
. of proving that he did not build or improve for the purpose of sale.)
Plumbing
1 2A M
❑ 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 License Law
does not apply to an owner of property who builds or improves thereon, and who contracts -for
such projects with a contractors) licensed pursuant to the Contractor's License Law.) - -
❑ I am.exempt under Sec. B. & P.C: for this reason
S.M.I.•
' • TA _ 4 r
Grading
Driveway Enc.
Date owner
Infrastructure
-5.50
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
_ ❑ Copy, is filed.with the city. ❑ Certified copy is hereby furnished. .
TOTAL
$6, 419.25
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION. INSURANCE
REMARKS
(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.
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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
with such provisions or this permit shall be deemed revoked.
--
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
_-
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
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 Street Setback from Center Line
Side Setback from Property Line
Lender's Name
7 Lender's Address
' This is a building permit when properly filled out, signed'and validated, and is subject to
FINAL DATE
INSPECTOR
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.
' '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.
ISSued:by:
Validated.by:
g y ��rp
Date 4 A CiPermit .
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
T
HARD COPY
�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
ROCK STORAGE
HEATING (FINAL)
OTHER APPJEOUIP.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING,
CAR P. SQ. FT. @
WALL SQ. Ff. @
DRINKING FOUNTAIN
URINAL
SO. FT. @
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
I
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 a 1.Va 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
HEATING & AIR COND. SOLAR
A.C. UNIT
COLL. AREA
HEATING (ROUGH)
STORAGE TANK
DUCT WORK
ROCK STORAGE
HEATING (FINAL)
OTHER APPJEOUIP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
REMARKS: