04457 (SATT)a -. •, 'I"�",��• , � t � a .i;
P.O. BOX 1504
Building 78-105 CALLE ESTADO „.• , • ,- .
Address ' �'� F LA QUINTA,.CALIFORNIA 92253
Owner,=sy c y}.
BUILDING:'TYPECONST. OCC: GRP "
Address .75-005 Count" Club mriV4
CityZip Tel.
P&10''Deser 9226E
Contractor
Nationlal Mortgage
Address
Saiz
City Zip Tel.
..State Lic.
& Classif.
Arch., Engr.,
Designer
Address
288130
A -.P.- Number, .:PqA jioert — The Gre( 4 +'
Legal Description . M.
ProjectDescription' � Y Plan C
Lic•# 398 Sq. Ft., . 1700 , . „ No.. .
r Size Stories
Tel.
City( Zip I
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. 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 that. he 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 ($500).
O 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
builds or improves thereon and who does such work himself or through his own employees,
Provided that suchImprovements ere 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 of sale.)
O 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.)
O 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
O Copy is filed with the city. O 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 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
Laws of California.
Date Owner
• .I
No. Dw:' .
Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
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 Center Line '
Estimated Valuation
$110 r S74
•ti
PERMIT
Rear Setback from Rear Prop. Line
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
I hereby affirm that there is a construction lending agency for the performance of the
Const.
*Abu 4,3V
Mech.$u
work for which this permit is issued. (Sec. 3097, Civil code.)
1!E
Electrical
Side Setback from Property Line'
Jia y ou
Plumbing
► a VU
S.M.I.
-.
Lender's_ Address
Grading
a�
Driveway Enc.
- This is a building permit when properly filled out, signed and validated, and is subject to
Infrastructure
.04r
JA5,08 Crri alac�i+''-
h ,+
Net InVr stjn-, cturea. r i►�e i1 x srw
I certify that I have read this application and state that the above Information is correct.
1
Issued by:
-i
TOTAL
1p4 12 9 Y s
,est � $ , ILI !
REMARKS
'
construction, and hereby authorize representatives -of 'this city to enter the above-
mentioned property for inspection purposes.
Validated by:
. NOTICE TO APPLICANT. If, after making this Certilicatelof 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 Center Line '
'
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY ;
Side Street Setback from Center Line'I
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.)
Side Setback from Property Line'
i=
Lender's Nam
Lender's_ Address
a�
- This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
� NSPECTOR-
.#It
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.
1
Issued by:
a •
Date Permit
,. 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
z ?
:, ■ _ WHITE FINANCE, PINK APPLICANT,' GREEN'- BUILDING, GOLDENROD
ASSESSORS OFFICE, HARD COPY FILE;
-._ r,_:'fi?'.. ?�-.sr- .....c. �'.,. ..,.is ..:.l;..- .:;-�. ...,.r -!.... .- .,-�.�,••:�w`-,_
,.. t. ...... _...�-.E-e...
-:.1w. �.,r_. _ _� ._s. .., w.+s<..�...-. �7�'tt•
'�:�,•.�'�6d�:^fr ..
CONSTRUCTION ESTIMATL
NO, ELECTRICAL FEES
NO. PLUMBING FEES
1S1 FL SO Fl tR $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
SVC.
BAR SINK
POR SO FT. aMOBILEHOME
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. to
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO F7. �
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT.
=E
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. rd
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.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
FIREPLACE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 1'A c
SEWAGE DISPOSAL
SO.FT.GARgr 3/Ac
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.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. ya.
$ _plus_x$
=E
LUMBER GR.
FINAL INSP.
- FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
A TION i%
!�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATYRESlINITIALS
GARDEN WALL FINAL