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04034 (SATT)Building Address Owner ,'-"Mailing Address City TAht 4.4Q t: P.O. BOX 1504 �;� 78-105 CALLE ESTADO _ Apia Fielft LA,QUI.NTA, CALIFORNIA 92253 ,- Stjixiftsa Company 75--005 Country Club Dr Contractor - Address 0, City State Lic. & Classif. 2-8130 • Arch., Engr., Designer Address Zip JTel. BUILDING:'' TYPE CONST. OCC. GRP. iV8 A.P. Number PGA Veli Jol Th1!!t Greens "' w• Legal Description ---------------- Project Description Plan A Sana 3r. Zip Tel. City Lic. # 298 r, ..� _ . Sq., Ft. 170()+ .`�.. No. 2 No. DwA Size St"o�ies Units • ' New ❑ Add ❑. Alter ❑ Repair ❑ Demolition ❑ el. 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 effect. .�...r~,t' r r 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 permit 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 thathe 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 five hundred dollars (8500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness 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 thatsuch 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 of proving that he did not build or improve for the purpose or 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 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 ) mmated valuation $12.769 Grading PERMIT AMOUNT • Plan Chk. Dep. Plan Chk. Bal. 1.4 11, Const. 4W1 • '"tV Mech. Electrical WORKERS' COMPENSATION DECLARATION Plumbing TUSa0U S.M.I.q - Grading ❑ I am exempt under Sec. B. & P.C. for this reason Driveway Eno. Date Owner Infrastructure ;d f 114 •:3 L. WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of - - .. • '.� Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company - ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. TOTAL1�i#.C1:it.i.d%�""' CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE '- 3;A1',4 pr- �,RA AA1-1h Air,-f�.t4w$�(.�",•':..4� �f^t '(This section need not be completed i/ the permit Is for one hundred dollars ($100) valuation or less.) - I certify that in the performance of thg work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation' ^y�`} ;[ ASH � '�'j��'�4M � a7€ia 2t r�� 2 Laws of California. Date Owner - NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: • subject to the Workers' Compensation provisions of ;the Labor Code, you •must forthwith ,` comply with such provisions or this permit shall be deemed revoked.. Minimum Setback Distances: - ' Front Setback from Centel Line Rear Setback from Rear Prop. Line r CONSTRUCTION LENDING AGENCY' •the Side Street Setback from Center Line .- I hereby affirm that.there-is a construction lending agency performance of the:: ,for work for which this permit is issued. (Sec. 3097, Civil Code.). , "(' ••Side Setback frcm Property Line Lender's Name Lender's •. Address FINAL DATE t INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to r uexpiration if work thereunder is suspended for 180 days. N,y,� _ I certify that I have read this application and state that the above information is correct. ' Issued by, { -Date Permit I agree to comply with all -city and county, ordinances and state laws relating to building„•. , -.: construction, and' hereby, authorize representatives -of this` city -to enter the above rr- ', mentioned property for inspection purposes. ' r i . 'Validated by: + r” Signature of applicant' - Date- ate r F` Mailing Address ' - - -Mailing 'Validation: r 'c , ' ?- dQ City, State 'Zip •r GOLDENROD }ASSESSORS OFFICE'H%RD COPY - FILEt WHITE FINANCE PINK APPLICANT GREEN BUILDING, r ^�. :rt►�'at��. �r„�'%�'.'•$+L'.x'^e ., k, .� ji.P �.��_. ,J 2J- Lrw�KK!1�5..•�.3`^.'..+4_..C�F H.`•.c>� .1 ._�?G�} .2!L.4..cr'F a' f,'�+•,.: ,. �°�i'�e°4w;N.._':i ,`:. .. _y.. �#•r ;'.'...��-,.'”.+k �1.n, ..... .:5, .;>r!'-.. .,...L� �_':. .... «� CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT y S UNITS SLAB GRADE 2ND FL SO F1. C BONDING YARD SPKLR SYSTEM POR SO' FT. Qr MOBILEHOME SVC. BAR SINK GARSO. FT. a POWER OUTLET ROOF DRAINS FOUND. REINF. GAS (ROUGH) DRAINAGE PIPING CAR P. I SO FT. a OTHER APP.IEOUIP. REINF. STEEL WALL SO. FT. @ TEMP. POLE DRINKING FOUNTAIN SO. FT. fd GROUT URINAL ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. WATER PIPING NOTE: Not to be used as property tax valuation WATER SYSTEM FLOOR DRAIN MECHANICAL FEES =$ WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED 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 SPARK ARRESTOR SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID Q I c SEWAGE DISPOSAL LATHING SO.FT.GAR (g Ii c HOUSE SEWER MESH GAS PIPING PERMIT FEE INSULATIONISOUND 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 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.IEOUIP. 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 INSULATIONISOUND FINISH GRADING N L CTION CERT' OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL