003419 (CONR)CV
P.O. BOX 1504 ' No. 003419
Building 78-105 CALLE ESTADO
Address 55-90-5 PGA BlVd. LA QUINTA, CALIFORNIA 92253
Owner
Landmark Land Coo BUILDING: TYPE CONST. OCC: GRP. -
Mailing
Address V 9lfnn
A.P. Number »A Vs,a,Q,r
City Zip Tel.
�>L�ira .... 9225'3 564-2805 Legal Description
Contractor Project Description �urad tennis courts per
Landmark Land Ccmnanv a>s�prc�eer� Plan
Address .
City' ]ZIP Tela .
1200 .cubic vards-i`..ill.
1100. cubic Yards cat
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
413b36 Size • Stories Units
Arch., Engr.,
Designer New ❑ 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 Business and Professions Code, and my -license is in full force and
1i i f
SIGNATURE , - DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for'the following Estimated Valuation .
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 -
requires the applicant for such permit to file a signed statement that he is licensed pursuant, to ... PERMITAMOUNT
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.
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, 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 - - -
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. (Seca 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.)
0 I am exempt under Sec.- B. t: P.C. for this reason Grading C0A Al
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. Company -
❑ Copy is filed with the city. 0 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 lhp work for which this permit is issued, I shall not
employ any person in any manner so as to becomesubject to the -Workers' Compensation" IVL,fi.j ri ! t V1 fit- i' CJ •':'
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 heieby 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 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 sof this city to enter the above-.
-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address ,
City, State, Zip
HARD COPY
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 1m"//87Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. 1 SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. ? SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL ` SQ. FT. ®
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SO. FT.
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
{ MECHANICAL FEES
SYSTEM
WATER SOFTENER
VENT SYSTEM FAN l EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT f CFM
KITCHEN SINK
ABSORPTION SYSTEM. } B.T.U.
ITEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR f HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
j
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/ac
HOUSE SEWER
I
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 I PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK I
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.IEQUIP.
REINF. STEEL 1
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAMWATER
SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR. `
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
r
VENTILATION
FIRE ZONE ROOFING j
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH )
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION f
CERT. OCC.
FENCE FINAL . )
f
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL