04347 (SATT)M4 .<
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 554249 Tanglewood ",..LA QUINTA, CALIFORNIA 92253
Owner ^ +
Mailing- BUILDING: TYPE CONST. OCC. GRP.
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Address 7S—OOS Country Club Drive. _ A.P.,N,urnber PCA West w The Greens
s
City Zip Tel.
Palm Denrrt92260 566.2$28 Legal Description
Contractor Project Description Plan DR ~ "" Phase 7C
Address
City Zip Tel.
«. m
State Lic. City -
& Classif. 288130 Lic. # .,9. , Sq. Ft.. ��W No.. w . , . d No. Dw.'
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City
Zip
State
Lic: #
•
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r LICENSED CONTRACTOR'S DECLARATION
H
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Divislon 3 of the Business and Professions Code, and my license is in full force and
effect '�,.r•�
effect.
' �•SIGNATl1RE' DATE
�?:` •L OWNER•BUILDER DECLARATION
:-; ' i •Estimated
Valuation
.`,tali}yl`hereby affirm that I am exempt from the Contractor's License Law for the following
Any
$110t156
'
reason; -.'(Sec. 7031.5,Business and Professions Code: city or county which requires a
-
t? permit; to construct, atter, Improve, demolish, or repair any structure, prior to its issuance also
permitlicant for such censed
statement that he is
PERMIT
AMOUNT'
nffpotoftheContractor''Law,Chapter9 (commencing witned
snsopLicense h Section o
."Division 3 of the Business and Professions Cade, or that. he is exempt therefrom, and the basis
for Any Section 7031.5 by 'any for
Plan Chk. Dep.
,• the alleged exemption. violation of applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (E500).
Plan Chk. BBI.
❑ 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
C0r1St.e'
r
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,
Mech.
- :i'.4,
provided that such 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
Electrical
C3
. of proving that he did not build or improve for the purpose of sale.) i
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
PlumbingVy�,i
-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
improves for
.. 7. 7 .
','�ait v
does not apply to an owner of property who builds or thereon, and who contracts
. • such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
S.M.I.
Grading(
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❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner
Infrastructure.
Less credit
Ir2Jo 0 b
' WORKERS' COMPENSATION DECLARATION
Met Infr s Mrub`ure.
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.
TOTAL+
�.aar �.��I.i'"•� .
' CERTIFICATE OF EXEMPTION FROM
REMARKS
4 '
WORKERS' COMPENSATION INSURANCE(3
(This section need not be completed if the permit is -for one hundred dollars (8100) valuation
v
`�i7't7sP'1"��G7.FXiLT-S'1T(' '
or less.)
_
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any son in any manner so as to become subject to the Workers' Compensation
Laws of California.o
NOTICE - TO APPLICO.•r
- ANTIf, after making , this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Distances:
'
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback
• ,�
Front Setback from Center Line'
-Rear
Setback ffom ReaiF 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
work for which this permit is issued. (Sec. 3097, Civil Code.).
4' �"
$Ida Setback ffom Property Line
Lender's Name
w Q
' Lender's Address
"
FINAL DATE
t
IN PECT,OR
• This is a building permit when properly filled out, signed and validated, and is subject to
f -
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 r
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-
e '
mentioned property for inspection purposes. •
Validated by:
Signature of applicant f Date
Mailing Address
Validation:
City, State, Zip '
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING,
GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE I '
II�k1•. -., Si: ,. l:�•ti llw�.., . a ..- .. .__ '��.'• , +. - . - .. ..�u t .. �r � .s .� - .1�„r...4 _ S�. •- ..•. ._ _ _
ti - _ ... .. ..�. .-. w.. .. . _.. .. .v . . -. • .. _
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO F1 (p $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. q
FORMS
SEWER OR SEP71C TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT at
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Or
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. a
FINAL INSP.
BOND BEAM
WATER SYSTEM'
DRINKING FOUNTAIN
WALL SO. FT. (d
-$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. (a
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.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
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 IIA c
SEWAGE DISPOSAL
SO.FT.GAR �i4c
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 & AIR COND. SOLAR
SETBACK
GROUND PLUMEING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEP71C 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
INSULATION/SOUND
FINISH GRADING
�C
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL