06802 (SFD)r 4 0
P.O. BOX 1504 No. 06802
Building 78-105 CALLE ESTADO
Address 54-379 Shoal Cmpk LA QUINTA, CALIFORNIA 92253
Owner
Sunrise C ony
Mailing - BUILDING: TYPE CONST. OCC: GRP.
Address 42-600 Cask St. #200 A.P. Number PGA WEST Phase 23A
City Zip Tel.
Palm ftger 92260 558-2828 Legal Description
Contractor Project Description Tract 20717-3. Plan 4C
National rand & Mortgage
Address
Sam
CityZip Tela
State Lic. City
& Classif. 2$6130 Lic. # 328 Sq. Ft. 291€1 No. No. Dw.
Arch., Engr.; Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolitiori ❑
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) t` of Division 3 of the Business and Professions Code, and my license is in full force and
effec""
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation $16
I hereby affirm that I am exempt from the Contractors License Law for the following A3 Ci
reason: (Sec. 7031.5,Buskness and Professions Code: Any city or county which requires a 232,
permit to construct, alter, improve, demolish, or repair any structure, prior. to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to 'PERMIT - AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) -of
Division 3 of the Business andProfessions Code, or that. he is exempt thereliom, 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 of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. ` 5b4. Z6
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
Professions Code: The Contractor's License Law does not appy 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. d, however, the building Mech.
or improvement is sold within one year of completion, the owner -builder will have the burden I
of proving that he did not build or knprove for the purpose of sale.) Electrical + `�
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo- Plumbing
struct the pr •ect. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not app/jP to an owner of property who builds or improves thereon, and who contracts for S.M.I.•
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 44988. 3 1'494. 1
Mess rea t 1s 04. its
WORKERS' COMPENSATION DECLARATION
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.
TOTAL 3,i
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE t n ^&Z< -r .:. sa "Y f- lA1 4 '• fi! '.r # fy
(This section need not be completed if the permit is for one hundred dollars ($100) valuation Y 7 w � ii�Lw . • ..1its„ Z 77
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
Date Owner
NOTICE TO APPLICANT: h, after making this Certificate or Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Comply with such Provisions orthis Pam* sha0bedeemed revoked. Minimum Setback Distances: -
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
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 160 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date 1l/
9%90 Permit
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-.
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
1ST 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. Ff. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. Fr. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT.
=$
LUMBER GR.
AL INS77
URINAL
SQ. FT.
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.COOL , HOOD
SIGN
WASHER(AUTOXOISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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 ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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 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.
AL INS77
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 SIGNATURFSIINITIALS
GARDEN WALL FINAL