04368 (SATT)Building, '.g
Address
Owner
4 .4 Qum&
P.O. BOX 1504
78-105 CALLE ESTADO
,,LA QUINTI,CALIFORNIA 92253
1 . . .1 � I - 7 - .
BUILDING:, TYPE CONST. OCC. GRP.
A.P. Number PICA Ilest -- The Greens
0.436-8
Mailing
Address k
7S '005'Country Club Drina __
City, Zip Tel. -tw
- pi Im. Desor 92-260 1 soa-,1826,
Contractor
Address
ty
State Lic.
& Classif. 28813-0
Arch., Engr.
Designer -
Address,
Legal Description
"
Project Description JiCR Phase 7G
Tel.
City
Lic. # Sq.,Ft_ J790 .No.
Size Stories
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. j
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, after. Improve, demolish, or repair any structure, pilot 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 foi a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
0 1, 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 of through his own employees,
,,j'�.%rided that such improvements are not intended or offered for sale. If, however, the building
,'.,!,,or4improvement is sold within one year of completion, the owner-buildei will have the burden
f proving that he did not build or improve for the purpose of sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
truct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
oes 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.)
0 1 am exempt
pt 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
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
Y.
No. Dw'
Units
New 0 Add 0,
Alter 0 hepair'O
. Demolition *0
WORKERS' COMPENSATION INSURANCE
•
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) I
I I certify that in the performance of thp 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
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
ZONE:
BY:
Plan Chk. Bal.
Minimum Setback
Distances:
Const.
tW
Mech.
J!a 0 VU
Electrical
.Ou,du
Plumbing
Side Street Setback from Center Line
S.M.I.
I I I I
Side from Property Line
Grading
Setback
Driveway Eric.
N
Infrastructure
VWA 0 4 ZVI tZ
INSREC' TOR
Mas Ur olu
7-
Intrast- ruic ture:
Aiii 443 *-vt�
I cer illy 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
TOTAL
construction, and hereby authorize represdritatives of this city to enter the above-
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
I I certify that in the performance of thp 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
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.
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 the'
I I I I
Side from Property Line
work for which this permit is issued. (Sec. 3097. CivilCode.)
Setback
Lender's -Name
N
Lender's Addressi.
FINAL DATE
INSREC' TOR
.,.This is a building permit when property filled out, signed and validated, and is subject to
rfi
expiration it work thereunder is suspended for 180 days.
.
I cer illy 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 represdritatives of this city to enter the above-
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
.Yalidation:
City, State, Zip
WHITE,- FINANCE, PINK -APPLI ANT, GREEN -BUILDING,
1 L
GOLDENROD - ASSESSOR'S OFFICE HARD COPY - FILE
4
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO FT (p $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
SPKLR SYSTEM
4N0 FL SQ FT. 9tYARD
FORMS
SEWER OR SEP -IC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Ft
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. 6
FINAL INSP.
WALL SO. FT. (d
WATER SYSTEMi
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
-$
URINAL
SO. FT. 0
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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.
SQ. FT. RESID g i V. c
SEWAGE DISPOSAL
SO.FT.GAR 3i.c
HOUSE SEWER
I P ION/
C/
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE 1 L.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBaNG
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEP -IC 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 SYSTEMi
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
INSULATION/SOUND
FINISH GRADING
I P ION/
C/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL