13632 (AC)T4hf 4 4 a"
P.O. BOX 1504
Building 54-162 Shoal Creek 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
PGA hest Residential Association Of
Mailing
Address 55^-940 PGA Blvd.
City Zip Tel.
La Quinta, CA $2253 1 771--2234
co2trasctok Yiestern Construction
Addy ss I
t X99 Jackal ]Drive, Ste. B
CityTel.
Bermuda DunesZip CA 92203 345-4537
State Lic.B .75573 City 329
& Classif. Lic. #
Arch., Engr.,
Designer
Address
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I liereby affirm that 1 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 rile 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).
❑ 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 such improvements are not intended or offered for sale. If, however, the building
or:irriprovement 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.)
❑ 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
ke1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worr's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polic No.i Company
O�y is filed with the city. ❑ 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 the 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. f C y
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
' 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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
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.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 13632
BUILDING: TYPE CONST. OCC.,GRP.
A.P. Number
Legal Description
Project Description Restroom
Sq. Ft. 35 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $1t000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
b.:3
Const.
15. U
Mech.
Electrical
21. 0U
Plumbing
.S.M.I.
. {i
Grading
Driveway Enc.
Infrastructure
TOTAL
b • 15
REMARKS
_
I ,� /n\ M
- I ill L_/--1
ZONE: BY: I " "" - - — 11 1" I
Minimum Setback Distances: U
Front Setback from Cenkyr Line t
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. g $
UNITS
BONDING
C r
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
DUCT WORK
ROCK STORAGE
GAS (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SO. FT. ®
GRADING
cu. yd.
$ -Plus-X$-=$
WALL SQ. FT.
DRINKING FOUNTAIN.
FINAL INSP.
URINAL
SQ FT ®
REMARKS:
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
IKITCHEN 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.
SQ. FT. ® c
BATH TUB
INSPECTOR'S SIGNATURESIINITIALS
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT�FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE JPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
SLAB GRADE
FORMS
FOUND. REINF.
REINF. STEEL
GROUT
BOND BEAM
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL I
GARDEN WALL FINAL
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
GAS (FINAL)
TEMP. POLE
WATER HEATER
SERVICE
FINAL INSP.
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
FINAL INSP.
FINAL INSP.
REMARKS:
INSPECTOR'S SIGNATURESIINITIALS