06375 (SFD)Building 54-467 Shoal Creek
Address
Owner
�YtYi6e3 tAltti r'��
Mailing
Address 75.005 Gcmtxy Club
City Pa2,na Desert ZIp92260
Address
City IZip
State Lic.
& Classif. 2$$130
Arch., Engr.,
Designer
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA.QUINTA, CALIFORNIA 92253
No.
33
06375
BUILDING: TYPE CONST. OCC: GRP.
PGA Meet — PhaGe 21A
A.P' Number
�3 8 Legal Description
Project Description Tract 20717-3, PLm 2cM
Lic. # 3�2$
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000j of Divisibn 3 of the Business and Professions Code, and my license is in full force and
,'SIGNATURE - - 0 46�W 'DATE
f OWNER -BUILDER DECLARATION V 1
I hereby affi6n that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.S.Busbess, 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 We a signed statement lhat he is licensed pursuant to
the provisions of the Contractor's License taw, Chapter 9 (cormnencomg 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 awl penally of not more than five hundred do6'ars ($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 reproves thereon and who does such work hirrse/f or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the budding
or Improvement is sold within one year of completion, the owner-Wn7der will have the burden
of proving.that he did not build or irprove for the purpose of safe.)
❑ 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. R_ & P.C. for this reason
Date - Owner
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. (Sea 3800. Labor Cade.)
Policy No Company .
❑ Copy is filed with the city. ❑ Certified copy is hereby famished-
CERTIFICATE
amishedCERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or fess.)
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: ff, after maksng this Certitcate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provsions 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 property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 days.
I certify that 1 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--
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. 1548 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
BY:
AMOUNT
Plan Chk. Dep.`r
Front Setback from Center Line
Plan Chk. Bal.
Rear Setback from Rear Prop. Line
$ 549.94
Const.
671.00
Mech.
FINAL DATE
51.00
Electrical
9120/89
9$.15
Plumbing
Validated by:
131.00
S.M.I.
Validation:
7.63
Grading
Driveway Enc.
Infrastructure
$2,1442.28
1,221.14
Leena Credit
1,221.14
t
TOTAL
$2,729.77
a_ -TJ/
REMARKS
18", f-tIAy i.
Yotit I ?tn. i r
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
9120/89
Issued by:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
B GRADE Il�
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
OUND. REINF.*.AS
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
GRADING
cu. yd.
plus x$
_$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
/ G✓ w -
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
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. Fr. RESID ® 11/4 c
SEWAGE DISPOSAL
,/.MESH
IN SULATIONISOUNgr r� v�
SQ.FT.GAR ® V 4c
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
UND PLUMBINGNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE Il�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF.*.AS
1
(ROUGH Lam✓! 4
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.
INAL INSP
RAMING /- _,?,0
FINAL INSP.
RtkOOFING �a r
/ G✓ w -
?
l-� -tel �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING 57�
,/.MESH
IN SULATIONISOUNgr r� v�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL71
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