06809 (SFD)Buildin
Addr
ess 5$-323 `Shoal Creek
Owner
Stmrise Company
Mailing'
Address 42-600 Cook St. .S
City: lZip
Palm Deser• 52260
Contractor
•t national Lind a Hor
Address
P.O. BOX 1504 N o .
78-105 CALLE ESTADO .
LA QUINTA, CALIFORNIA 92253
088,09
BUILDING: TYPE CONST. OCC: GRP.
Q A.P. Number PGA WEST — Pha"_ 23
Tel.
5568-'2828 Legal Description
Project Description Traci 120717-3e Dian 2CR,
P
State Lic. I City
& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
City' Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I alicensed under provisions of Chapter 9 (commencing with Section
-1 of Division 3 of tm he Business and Professions Code, and my license is in full force and
• effect � �..�-
SIGNATURE I DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
Permit to constnict, after. Improve, demolish, or repair any structure, poor to its issuance also
requires the appfcant for such permit to 1176 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 vkrlal ion of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penally of not more than five hundred dollars ($500).
❑ 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 or through his own employees,
r provided trial* such Irtprovements are not Intended or offered for sale. If, however, the'building
or Improvement Is said 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 I
Sq. Ft. 154 'No. No. DIN
Size Stories Units
New ❑ Add ❑- Alter ❑ Repair ❑
[Estimated Valuation
PERMIT
Plan Chk. Dep. •
Plan Chk. Bal.
Const.
Mech.
Electrical
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License.Law
does not apply to an owner of property who bubds or Improves thereon, and who contracts for - S.M.1.
.= such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION F
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
❑ Copy is filed with the city. ' ❑ Certified copy is hereby furnished.
y. ms's.. •i. <
Demolition ❑
TOTAL
ic►fcy.�� r: ;3�_t..i ,,�
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
qr} i tk(3�� ±• ,> { „( st,•f q R
(This section need not be
(1h' completed ff the permit is for one hundred dollars (8100) valuation'..
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
'
_ employ any person in any manner so as to become subject to the Worker ' Compensation
Laws of California
' Date Owner `
NOTICE TO APPLICANT: ff, after making this certificate of Exemption you should become ''
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provfsionsorthis permit shall bedeemed remked. ,
-
Minimum Setback Distances: • -
'm
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
,Side
• work for which this permit is issued. (Sec. 3097, Civil Code.)
Setback from Property Line
Lenders Name
Lenders Address
FINAL DATE
INSPECTOR
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.
y p
1/9/ 9V
I certity 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 representatives of this' city to enter the above .
mentioned property for inspection purposes.
Validated by:.
Signature of applicant Date
Mailing Address
Validation:
City,. state, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
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. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ FT ®
/
INAL INSP�—�/��
[[[
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
I
I 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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM'
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
/
INAL 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