05041 (SFD)1 4
P.O. BOX 1504 N Q . 050(41
Building 78-105 CALLE ESTADO
Address 34"`803 Shoal Creek LA QUINTA, CALIFORNIA 92253
Owner
Sunrise CompanyBUILDING: TYPE CONST. OCC, GRP. -
Mailing
Address
..A'.fi f`es t"fa C. em A.P. Number unott" Pl{nA^ 30A
City Zip Tel. w
"art f%5r,824Q 0 Legal Description
Contractor Project Description >s r .. A Q
Address
City rs;aG Zip Tela
State Lic. City
& Classif. 1 Jv Lic. #2 �, Sq. Ft. No. No. Dw.
Arch., Engr., Size , $ i$ Stories - Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 f
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNEWBUILDER 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
permit to construct, alter, 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 exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a cin? penalty of not more than five hundred dogars (5500). .
❑ 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, Bufsness 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 herself or through his own employees,
provided Nat' such improvements are not intended or offered for sale. ff, 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 )
mmatea valuation
132.816
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal
$ 442..73
Const
515.5+
Mech.
34.00
Electrical
74.69
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
87.50
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner o1 property who builds or improves thereon, and who contracts for
S.M.I.
9.28
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner
Infrastructure
$2,988.3$ 1.494.18
.i�Q --#-Ad
1,494.18 -
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) vahration
AW; t. AK,' ra 0 Z' UAL # 2 ZO" cats. 10
or less:) -
I certify that in the performance of thF work for which this permit is issued, I shall not
AN; C..""J; 4 r Ki f-YYS„ 4 +,U. _p
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY: -
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shag be deemed revoked.
Minimum Setback Distances:
CONSTRUCTION LENDING AGENCY
I hereby affirmthat 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
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 -
I certity that I 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
ateMailing Address
City, State, Zip
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
12/23/$$
Issued by: Date Permit
Validated by:
Validation:
(/'. /2 I'm
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
'1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
ER OR SE 'f��C
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
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 SQ. FT. ®
=$
LUMBER GR.
FINAL INSP.
RAMING
URINAL
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
REMARKS.
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(AUTOx01SH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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.
SQ. FT. ® c
BATH TUB
NISH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/. 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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SE 'f��C
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEELS
(FINAL)
TEMP. POLE
GROUT
WATER HEAT.(R
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
RAMING
FINAL INSP.
ROOFING
REMARKS.
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
SULATIONISOUND
NISH GRADING
/.
ANAL INSPECTION 7
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL