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06376 (SFD)P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 54-5137 Sbo'l Geek LA QUINTA, CALIFORNIA 92253 Owner 3 _ I ti>E rlse- Cii9$DMV Address'75-005 E.8lt try Club City lZip ITel. Contractor S(9tae , _- Tel: . Tela State Lic. 2881313 City 32$ & Classif. Lic. # Arch., Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section 71100) of Division 3 of the Business and Professions Code, and my license is in full.force and effectf�w SIGNATURE DATE ' OWNER -BUILDER DECLARATION 11 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 permit to construct, after, improve, demolish, or repair any slNcture, prior to 8s issuance also requires the applicant for such permit to We 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 violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($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 or property who builds or improves thereon and who does such work himseN or through his ownemployees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not (wild or improve for the purpose of sale.) ❑ I, 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. 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 Workers 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 if the permit is for one hundred dollars ($100) valuation or less.) 1 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 making this Certificate of Exemption youshould become subject to the Workers' Compensation provisions of the tabor Code, you must forthwith comply with such provisions 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.) Lenders Name Lenders Address 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. 1 certity that I 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 gelating 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 ;�w Iep No. 06376 11LDING: TYPE CONST. OCC: GRP. P. Number PGA West — Phase Z A egal Description roject Description_ Tract 20717-3R Plan 3CR stimated Valuation O08,727 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. $ 563.06 Const. 688.50 Mech. 51-00 Sq'Ft. Size "' ltf*9x No.- Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Driveway Enc. Infrastructure 1,279.0 8s Cialt -s a TOTAL' c stimated Valuation O08,727 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. $ 563.06 Const. 688.50 Mech. 51-00 Electrical 141.12 Plumbing 131.£3€ S.M.I. 7.93 Grading Driveway Enc. Infrastructure 1,279.0 8s Cialt -s a TOTAL' c REMARKS •,c^ara�A �n og's.,e , tt„rs� t�ci -off 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 DATEN,yEFT�OR Issued by: —Date_Permit Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES' 1ST FL. SQ. FT. ® $ UNITS B GRADE �O �Jo G ROUGH PLUMB.BONDING YARD SPKLR SYSTEM 2ND FL SO. FT. FORMS ER OR SEPT(jj K ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. GAS (ROUGH `� METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SQ. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN WALL SQ. FT. ® LUMBER GR. NAL INSP_G% G r V�-- R—r-1j, ff/kFRAMINGFINAL URINAL SQ. FT. @ ��� � Q �� �i'1 ,1�, GU ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION FLOOR DRAIN MECHANICAL FEES FIRE ZONE ROOFING 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 HI 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® Vic HOUSE SEWER FENCE FINAL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE 7 NST. FEE fELECT.FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK OUNO PLUMBING /�i )�% % UNDERGROUND A.C. UNIT COLL. AREA B GRADE �O �Jo G ROUGH PLUMB.BONDING HEATING (ROUGH) STORAGE TANK FORMS ER OR SEPT(jj K ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. � GAS (ROUGH `� METER LOOP HEATING (FINAL) OTHER APPJEQUIP. EINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. y —Plus—X$-=$ LUMBER GR. NAL INSP_G% G r V�-- R—r-1j, ff/kFRAMINGFINAL INSP. ��� � Q �� �i'1 ,1�, GU REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL �f THING &' 9(2� L MESH uULATION/SOUND t�v FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL