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06369 (SFD)P.O. BOX 1504 Building .Y 78-105 CALLE ESTADO Address 54-515 Shoal Cxe ° " LA QUINTA, CALIFORNIA 92253 Owner Address 75-005 Couiatry Club City,Zip Tel. Palm Desi 9226th —2828 Contractor Sam Address City State Lic. 288130 (City r£ 325. Classif- Lic. # Arch., Engr., Designer 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 70pp)'of Division 3 of the Business and;Professions Code, and my_licehse is in full force and effect. _SIGNATURE rt r J'n�_.3 • 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 Penn# to construct, after. 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 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 exenption. Any violation of Section 7031-5 by 'any applicant for a permit subjects the appicant to a avd penalty of not more than Ove hundred dollars (5500)- 0 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, .provided that such irprovements are. not intended or offered for sale., If, however,, the building orimprovement is sold withinone 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, as owner of the property, am exclusively contracting with licensed contractors to corF struct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contraclor(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 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. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff 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, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner N077CE TO APPLICANT: ff, 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 Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Cfwl Code.) Lender's Name Lenders Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that 1 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 z-3 N o . 06369 11LDING: TYPE CONST. OCC: GRP. P. Number PGA Vest — Phase 21A Legal Description Project Description Tract 20717-3, Plan iC� Sq. Ft. 1333 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ (Estimated Valuation $94,224 PERMIT AMOUNT Plan Chk.-bep: Plan Chk. Bal. $ 500.41 Const. 617,00 Mich. 51.00 Electrical 89.99 Plumbing 96.00 S.M.I. 6.65 Grading Driveway Enc. Infrastructure $2,120.49 1,060.25 T&sa- Credit 1,N0.25 TOTAL $2,421.30 1 REMARKS A6r c #s )P-4191--95-99 .419--? k-99 f:iIV iny;i C i1LF:i- A is,i Z Y 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 9/20/89. Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL. SO. FT. DUCT WORK ROCK STORAGE F D. REINF. MOBILEHOME SVC. BAR SINK POR. SO, FT. ® EINF. STEEL GAS (FINAL) TEMP. POLE POWER OUTLET ROOF DRAINS GAR. SO. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRAINAGE PIPING CAR P. SO. FT. ® LUMBER GR.` CFI -'NAL INSP. ' ' �J C RAMING /_ /2 I FINAL INSP. DRINKING FOUNTAIN WALL SO. FT. ® REMARKS: URINAL SO FT ® 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(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM MESH 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. SO. FT. ® c BATH TUB CERT. OCC. SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL INSPECTOR'S SIGNATURESIINITIALS SO.FT.GAR ® 3/ic HOUSE SEWER GARDEN WALL FINAL 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 COND. SOLAR SETBACK OUND PLUMBING �-CUNDERGROUND A.C. UNIT COLL. AREA B GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS ) // EWER OR SEPT4t� ROUGH WIRING DUCT WORK ROCK STORAGE F D. REINF. GAS (ROUGHif -OJ_ METER LOOP [ HEATING (FINAL) OTHER APPJEOUIP. EINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. plus x$ =$ LUMBER GR.` CFI -'NAL INSP. ' ' �J C RAMING /_ /2 I FINAL INSP. ROOFING !Lll - (-A {e Ole f REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL gALLATHING MESH /INSULATION/SOUND t FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS ' GARDEN WALL FINAL t