06815 (SFD)T4"tvl 4 4 Q"
Buildin
AddressW275 Shoal Creek
Owner
Saritri se Cogmny
Mailing
AddreSS •A Inn
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.
Palm Deserd 92264 555-2828
Rational Land &
Tela
State Lic. I City
Classjf. 284130 Lic. If 328
Arch., Engr-,
Designer
Address Tel.
City IZip ISt to
Llcumm CONTRACTOR'S DECLARATION
1 affem 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
SMAIATU E DATE
OWNER -BUILDER DECLARATION
hereby affirm hatpm the Contractor's License Law for the followingS�nsde:Ay
reasort city or county which requires a
Permit to construct. ata Improve. demolish, or repair any structure, prior to its Issuance also
requires Yue applicant for such permit to fie a signed statement that he is licensed pursuant to
Me prow'' s of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Obison 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the ategeo exemption- Any violation of Section 7031.5 by 'any applicant for a permit
subjects the iead to a civil penalty of not more than five hundred dollars (E500).
❑ 1, as owner of the properly„or my employees with wages as their sole compensation, will
do the wodS and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contactors License Law does not apply to an owner of property who
odds or bzpn ves thereon and who does such work himself or through his own employees,
provided ” such irprovanvns are not intended or offered for safe. d, however, the building
or irp —ned is sold withii are year of completion, the owner -builder will have the burden
of provft #tat he lid not buildor irprove 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 eon bactor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sea B. & P.C. for this reason
Date Owner
WORKERS COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy Nn Company
❑ Copy is filed with the city- ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
Mbs s1edon need not be completed ff the permit is for one hundred dollars ($100) valuation
orless.
I cenUfy 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
Lams of California
Date Owner
NOTICE TO APPLICAW, A after malmg this Certificate of Exemption you should become
subject to the VANkers' Compensation provisions of the Labor Code, you must forthwith
ompy rir such provisitus or this pemd shag 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.)
Leaders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above information is correct.
1 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
meMiared properly for inspection purposes.
Signature of applicant— Date
Mailing Address
City. State, zip
BUILDING: TYPE CONST
No.
OCC: GRP.:
06815
Number PGA WEST - Prise 23A
Description
:t Description Tract 20717-3, Plan 4CR
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 119/94 Permit
Validated by:
Validation:
Sq. Ft. 11318
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$132x816
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
04+ Zia
Const.
Mech.
Electrical
I rV4
Plumbing
I 3 . Cil
S.M.I.
19, 31
Grading
Driveway Enc.
Infrastructure
$2 s 8.36
i! 94.
MUSS Clivdit
19494.18
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 119/94 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
I
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ. FT.
oe
NAL 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.COOL HOOD
SIGN
WASHER(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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3bc
HOUSE SEWER
FINAL INSPECTION
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 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
oe
NAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL