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05026 (SFD)Q 2. 4 46u P.O. BOX 1504 Building 78-105 CALLE ESTADO Address 54-767 Shoal Cree-k LA QUINTA, CALIFORNIA 92253 Owner J Mailing " Address 42-600 Cook Street, Suite -,20Q City Zip Tel. Palm Desett 92260 564�2628 Contractor 'National Mortgaste _ Address Tela State Lic. City 8 i & Classif. Lic. # $28 Arch., Engr., Designer Address Tel - City lZipStateI Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7fMMl) of Division 3 of the Business and Professions Code, and my license is in full force and effect SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason:. (Sec. 7031.5,Busmess and Professions Lode: Any city or county which requires a permit to constrict, atter, 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 Goensed pursuant to the provisions of the Contractor's License Law, Chapter 9 ficom mnencing 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 five hundred dollars ($500). ❑ 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 improvements are.not intended or offered for safe. H, however, the building or improvement is sold, within one year of completion, the owner -builder wig 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 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, g, P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, tabor 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 dogats ($100) 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: ff. after mabV 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 pemnit 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 properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify 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 above- mentioned property for inspection purposes. \ Signature of applicant Date Mailing Address City, State, Zip No. 0502,6 11LDING: TYPE CONST. OCC: GRP. P. Number • PGA West ` Phase 19A ,Legal Description Project Description Plan 'ICU Sq. Ft. 1330 No: No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $94,224 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Q 342.49 Const. 4 j 8 � 00 Mech. 34.00 Electrical ry Plumbing 87.50- 7*S0- S.M.I. S.M.I. 6.62 Grading Driveway Enc. Infrastructure S02-,120.49 A 1,060425 1,1360-25 TOTAL2.�$.$a� REMARKS titaYx is.qA_� I'{ 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 12/22/88 Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1STFL. Cl SQ. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS R OR C K ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GA OUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR. SO. FT. ® TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO. FT. ® FINAL INSP. BOND BEAM WATER SYSTEM DRINKING FOUNTAIN. WALL SO. FT. =$ LUMBER GR.' FINAL INSP. URINAL SOFT ® ROOFING ESTIMATED CONSTRUCTION VALUATION $ /��jr�j 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(AUTO)(DISH) 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® VAc 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 R OR C K ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GA OUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR.' FINAL INSP. RAMING FINAL INSP. ROOFING �%`/%, /J /��jr�j REMARKS VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR AR. FIREWALL l HING ?Ll' MESH NSULATION/SOUND FINISH GRADING XINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS ' GARDEN WALL FINAL