04358 (SATT)• , T
.
4,�., u�l'ItiCv
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address .'"�� LA QUINTA,.CALIFORNIA 92253 "
Owner, �A
mise company BUILDING: TYPE CONST. OCC. GRP.
Mailin
Address%s-005 countey Club Dr ve kf W .. The Gri'�isn# lid
T1p Tel.
•1��,'BSt' �3€R r 92260 „ ����";��f��i , � Legal Description
ContractorProject Description Plan ER Phase 7G
Hatit nal Mo"gags ,
Address w
City Zip Tel. w f
State Lic..` City
& Classif. 208130 Lic. # 396 Sq. Ft. 1700 No. 2 No. Dw.
Size Stories Units r
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ „ Demolition ❑
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.Professlons Code, and my license is in full foicefand -
SIGNATURE- - DATE w ,
OWNER -BUILDER DECLARATION Estimated Valuation qR�i "
I'hereby affirm that 1 am exempt from the Contractor's License Law for the following Af
reason: -(Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a $
69
permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also - F
requires the applicant /or such permit to file a signed statement that he is licensed pursuant to PERMIT - AMOUNT'
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ 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 Plan Chk. Dep.
subjects the applicant to a civil penalty o/ not more than five hundred dollars ($500).
Plan Chk. Bal.
,O I, as owner of the property, or my employees with wages as their sole compensation, will
b
I,.,,,a,do•the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. R
s`.Fro(esslons Code: The Contractor's License Law does not apply to an owner of property who
•'�'� builds or improves thereon and who does such work of
or through his own employees,
ment
ne ear
pro
that such improvements are not intended or ollered /or sale. I/, however, the bu(kling Mech. Jlfi
!' � of p ovingthat he did eof buiwitld/or improve fo�the purpose sale.)wner-builder will have the burden Electrical
• p I, as owner of the property, am exclusively contracting with licensed contractors to con,Plumbing '»-
c-stru.t the project. (Sec. .7044, Business and Professions Code: The Contractor's License Law . -
-does not apply to an owner 0/ property who builds or improves thereon, and who contracts for S.M.I. ,'' 8 644
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading .
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date' owner Infrastructure # •
-
WORKERS' COMPENSATION DECLARATION set lit rast 1 +more ?a r 3$13166
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. ❑ Certified copy is hereby furnished.
TOTAL ;+.L y 4 7,V .4 1A l .� �>✓' >
R. l[
CERTIFICATE OF EXEMPTION FROM REMARKS - •
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation ? 7}i'q 4'�`('^s�''~#A•:$ii!
or less.)
I certify that in the performance of thg 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 t
Laws of California.
Date Owner
NOTICE TO APPLICANT., If, aRer,i making this Certificate of Exemption you should become ZONE: BY: -
subject to the Workers' Compensation provisions o/ 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
Work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's' Name `
Lender's: Address ----_=FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to �! „
expiration it 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 c
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 " a`
mentioned property for inspection purposes. I � . �' Validated by: . `
z
Signature of applicant Date
Mailing Address - L _ � Validation:'
City, State, Zip
f` tr M•� , {4 L WHINE -..FINANCE, PINK- A�PPLICANT,IGREEN - BUILDING, GOLDENROD, -wASSESSOR'S OFFICE, HARDCOPY -'FILE x ,,�, • -,• �, .r;� ,. � �
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT y $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT g
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. IF
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. ft
FINAL INSP.
WALL SO. FT. @
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$pIUS x$
=$
URINAL
SO. FT. rd
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(AUTO)(DISH)
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. (g c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID I 1 c
SEWAGE DISPOSAL
SO.FT.GAR (g Vic
HOUSE SEWER
I CTI
i
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.
$pIUS x$
=$
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 CTI
i
CERT. C.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL