04027 (SATT)T4ht 4 4v Q"
.0404'. 7
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7tof Division 3 of the Business and Professions'Code, and -my license is in full force and
effec
_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,Susiness and Professions Code: Any city or county which requires a
permit to construct, atter, 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
W
r the alleged; :exemption. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the:appf'cant to'a'cfvfl penalty of not more than rive hundred dollars (E500).
i,: la' :
O I, as owriei.of. the property, or my employees with wages as their sole compensation, will
do the'w0 ,r'ndift ,- structure is not intended or offered for sale. (Sec. 7044, Buisnass and
Profess ions`Code"'he Contractor's License Law does not apply to an owner of property who
builds or mpioves"thereon and who does such work himself or through his own employees,
provided that such improvements ere not intended or offered for sale
. d, however, the building
or improvement fs, sold within one year of completion, the owner -builder will have the burden
of proving the, he did not build or improve for the purpose o! 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 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 parson in any manner so as to become subject to 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
Ihereby 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 of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zlp
P.O. BOX 1504
Buildings
'�1��
X74
$110474
78-105 CALLE ESTADO
PERMIT
Address
AMOUNT
Plan Chk. Dep.
LA.QUINTA„CALIFORNIA 92253
Owner
Const.
4b1(7 9
si2xli�.4E3 CompanyMailing
3 e
Electrical
$ •
Plumbing
BUILDING: TYPE CONST.
OCC. GRP.
Address
755„005 C'Cy1xi trV Club
Dri4t; A.P. Number. PGA West
- The Greens
City
V8lm
Zip
Reser492260
Tel.
568•."828 _ .. Legal Description
Contractor
s`4v
Plan CR
— Pbase 2Catiolal
Mortgage
- Project Description
Address
TOTAL
Swaa
REMARKS
City
Zip
Tel.
State Lic.
&Classif.
288130
City
Lic.#
$q. Ft.No. _
Size Stories
No.Dw.
Units
Arch., Engr.,
New ❑ Add ❑ Alter ❑
Repair ❑ Demolit:on ❑
Designer
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
7tof Division 3 of the Business and Professions'Code, and -my license is in full force and
effec
_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,Susiness and Professions Code: Any city or county which requires a
permit to construct, atter, 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
W
r the alleged; :exemption. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the:appf'cant to'a'cfvfl penalty of not more than rive hundred dollars (E500).
i,: la' :
O I, as owriei.of. the property, or my employees with wages as their sole compensation, will
do the'w0 ,r'ndift ,- structure is not intended or offered for sale. (Sec. 7044, Buisnass and
Profess ions`Code"'he Contractor's License Law does not apply to an owner of property who
builds or mpioves"thereon and who does such work himself or through his own employees,
provided that such improvements ere not intended or offered for sale
. d, however, the building
or improvement fs, sold within one year of completion, the owner -builder will have the burden
of proving the, he did not build or improve for the purpose o! 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 contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i1 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 parson in any manner so as to become subject to 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
Ihereby 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 of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zlp
WHITE FINANCE, PINK -, APPLICANT, GREEN - BUILDING, GOLDEN290 - A05E6SOR'S OFFICE, HARD COPY - FILE
Estimated Valuation
X74
$110474
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
4b1(7 9
Mech.
3 e
Electrical
$ •
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure'
s`4v
TOTAL
z?,,.i • �,�
REMARKS
Vqn)fM0-f)0-TF43 _,Y41
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 - Permit
.Validated by:
Validation:
WHITE FINANCE, PINK -, APPLICANT, GREEN - BUILDING, GOLDEN290 - A05E6SOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl (p s
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. tr
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. Cr
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. f�c
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. fd
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. 0
=$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. (g
ROOFING
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE, Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ILAUNDRYTRAY
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 a 114 c
SEWAGE DISPOSAL
SO.FT.GAR @ V:c
HOUSE SEWER
CERT. OCC.
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 PLUMBING ELECTRICAL HEATING 8 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 xs
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL :d