003642 (SATT)Building
Address 55-861
Mailing
Address 75_005 cc
City Zip
Palm Da:a 1-t
Contractor
NatiID�l
Address . ... _. .
State Lic.
& Classif.
Arch., Engr.,
Designer
2881.30
Zip
P.O. BOX 1504
78-105 CALLE ESTADO
ssio lal LA QUINTA, CALIFORNIA 92253
No. 003&42
FA, iAW41Z A A X BUILDING: TYPE CONST., OCC: GRP.
atrg club A.P. Number . PGA West
• Tel.
92260 .,568T2428, Legal Description
Project Description Fl2aie 5Bs Plan I'M
Tela "
City
Lic. # 328,....- Sq. Ft. D.WG 3054 No. No. Dw.
Size MU
A fafi Stories Units
New ❑ Add ❑ Alter ❑' . Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thatI4_. licensed under provisions of Chapter 9'(commencing with Section
7000) of Division 3ti11 the Business and Professions Code, and my license is in full force and
effect.
s
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
EStlmated Valuation
I ~`j�
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a
-permit
'
PERMIT -AMOUNT
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
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). - -
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
-
Plan Chk. Bal.
�. ..6 t IQ
Const.'
w as
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
Mech.
00provided
builds or improves thereon and who does such work himself or through his own employees,
that such. improvements are not intended or offered for sale. If, however, the building
Electrical
�{.',
or improvement is sold within one year of completion, the owner -builder will have the burden
.,proving that he did not build or improve for the purpose of sale.)
Plumbing
1,26 w 0Q
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.) -
O. I am exempt under Sec. B. 8 P.C. for this reason
_
S.M,I; •"
14 C
Grading
Driveway Enc.
Date Owner
i WORKERS' COMPENSATION DECLARATION
I hereby affirm that I heve 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. _
CERTIFICATE OF EXEMPTION FROM
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 tMs permit is issued, I shall not
employ any person- in any manner so as to become subject`lo 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
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
'This is a building permit when properly filled'out, signed and validated, and is subject to
expiration -it 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.
Signature of applicant Dale
Mailing Address
City, State, Zip
HARD COPY
Infrastructure 1% 4 7!325 «
TOTAL? F47. «int
REMARKS
t'Ifi to t t7•5 a is tlOrrCs fX')_ t 0_ttn 4 7
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
Issued by: Date 2/x,6/88 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. S0. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. 0
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
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
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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. 0 c
BATH TUB
MESH
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
SQ.FT.GAR g 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
--JDBL
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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
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 SIGNATURES/INITIALS.
GARDEN WALL FINAL