04447 (SATT)03,
P.O. BOX 1504
":"Building, 78-105 CALLE ESTADO
:Address 55-153 TanglewooA LA QUINTA, CALIFORNIA 92253 _
wrier
Sm. rise Company
Mailing:,
BUILDING: -TYPE CONST. OCC. GRP.
,` .
Address " 75-005 Country Club 7tw '{T`f ..... .. b • A.P. Number a DA West st ' i • Greens,
%Cityzip92260 Tel:568-�2828 Legal Description
Contractor,- Pbase Plan C r
Notional Mortgage Project Description
Address
'City Zip Tel.
State Lic. 288130 City 398,,..
& Classif. Lic. #
Arch., Engr.,
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
7000) of Division.3 of the Business 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.'.`703;1.5,Business and Professions Code: Any city or county which requires a
` permit : to.consfruct; altei, 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 or not more than five hundred dollars ($500).
❑ 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, Buisness and
Professions'Code: The Contractor's License Law does not apply to an owner of property who
hbuilds. or improves thereon and who does such work himself or through his own employees,
4, provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden
a of proving that he did not build or improve for the purpose of sale.)
❑ 1, 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.) ,
❑ 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 Nod Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL I y tG t 4,7 a 0,7 1 I ;-,) Irz) 9f -f s• 11, -1
CERTIFICATE OF EXEMPTION FROM
REMARKS
14
WORKERS' COMPENSATION INSURANCE'�
(This section need not be completed it the permit is for one hundred doflars ($100) valuation
J
1 1 ;,t;' 7r .`+ j V_Jii'"18A1 0 46.7 10
Sq. Ft. ;4�
Size
No.
Stories
No.
Units .
New O Add ❑
Alter ❑
Repair ❑ Demolition ❑
employ any person 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
ZONE:
BY: '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Minimum Setback
Distances:
Estimated Valuation
$10,PS74
+•e'..
PERMIT
.7' AMOUNT
Plan Chk. Dep.
Rear Setback from Rear. Prop. Line
Plan Chk. Bal.
$ 388 .97
Const.
460 . SO
Mech.
39i.00
Electrical
68.80
Plumbing
FINAL DATE
99.00
S.M.I.
-7.74
Grading
Driveway Enc.
Issued by:
Date Permit .
Infrastructure
VZ,r4131+92
iso Credit
11243.90
;
Not Mer"t ;r•t rture
3
Signature of applicant Date
Mailing Address
i
TOTAL I y tG t 4,7 a 0,7 1 I ;-,) Irz) 9f -f s• 11, -1
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE'�
(This section need not be completed it the permit is for one hundred doflars ($100) valuation
J
1 1 ;,t;' 7r .`+ j V_Jii'"18A1 0 46.7 10
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
n,
employ any person 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
ZONE:
BY: '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Minimum Setback
Distances:
comply with such provisions or this permit shall be deemed revoked.
- - t
Front Setback from Center Line -
Rear Setback from Rear. Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of thes.
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
,r /x
INSP�ECCTO�R-
x This is a building permit when properly filled out, signed and validated, and is subject to
i
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.
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.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
r WHITE - FINANCE, PINK - APPLICANT, GREEN.- BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY -.FILE '
t. ... _. ...c ..,. _. r � _r 'a«. ,:4. A... , ,..ems .... -.., ;,, • +i �. -
-
4s - - - - .F.. .. .... � t ._ S3's .
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT y Z
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. Q
FORMS
SEWER OR SEPT�C TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. of
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OUTLET
ROOF DRAINS
GAR SO. FT. aPOWER
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. 0
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. a
=$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. Id
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.0OOL HOOD
SIGN
WASHER(AUTOYDISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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 g 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR Q 3/,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 SEPT�C 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
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS -
GARDEN WALL FINAL