06428 (SFD)P.O. BOX 1504
Building5 24 $� f'1`Q�� 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
S=rtse - Compa"
Mailing
Address 42-600 Cook St. , #200
City I Zip ITel.
Address
Zip I Tel.
State Lic. City
& Classif. 288130 1 Lic. # 32$
Arcn., tngr.,
Designer
Address
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000),of Division 3 of the Business and Professions Code, and my license is in full force and
effect,, .� "'y+ `" A fl 1) f✓ter ``P r
+ � � ' / _ice ! J
_SIGNATURE 9' ' i f.;i' DATE
OWNER -BUILDER DECLARATION i
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5;8usiness and Professions Code: %Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, pilot to its issuance also
requires the applicant for such pemuT 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 or 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 cM 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
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The ConLactor'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 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 build orenprove for the purpose of safe.)
❑ 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 Sea 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. O Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
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: B, 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, Ciel Code.)
Lender's Name
Lender's Address
This is abuilding permit when properly filled ou% signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I car ity 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 relating to building
construction, and hereby authorize representatives of this city to enter the abova:
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip'
No. 06428
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PGA Rest, Pisne 18A
Legal Description
Project Description _ _ ` rat --t 210711-3. P9.sm Im
-Z_
Sq. Ft. 1330 No. No. Dw.
Size Stories Units'
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$94,224
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
4 500141.
Const.
617.001,
Mech.
51.€30
Electrical
89.991
Plumbing
' 96.0
S.M.I.
6.655
Grading
Driveway Enc.
Infrastructure
$2,120.49
1,060.25
Less Credit
1,060.25
TOTAL
$2,421.30
REMARKS tt yy{{T� yy��yr gg / Ytt
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/ZS/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
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS 090
MOBILEHOME SVC.
BAR SINK
POR. SQ, FT. ®
DUCT WORK
ROCK STORAGE
D. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
EINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SO. FT.
GRADING
cu. yd.
-Plus-X$-=$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSe
WATER PIPING
NOTE: Not to be used as property tax valuation
6eOOFING .2.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
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
ND PLUMBING
A.C. UNIT
COLL AREA
B GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS 090
ER OR SEPTIC
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. REINF.
F,7,, --
(ROUGH) ,Y- 2 7q(j
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
EINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
y
GRADING
cu. yd.
-Plus-X$-=$
LUMBER GR.
FINAL INSe
FRAMING
FINAL INSP.
6eOOFING .2.
z
�2� �2-`� I^��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING _
MESH
INSULATIOWSOUND _
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL