05917 (CP)P.O. BOX 1504 No, 0597
Building 78-105 CALLE ESTADO
Address 54-864 Shoal Creek LA QUINTA, CALIFORNIA 92253
Owner
5tkr'i>I3e Covivany BUILDING, TYPE CONST. OCC: GRP.
Mailing
Address 42600 Cook st.
Suite 200 A.P. Number PGA West
City Zip Tel.
P.Do 92260 Legal Description
Contractor Project Description P,001 and spa
G B ftOi.ffi
Address
69-465 Pere; &I.
City Zip Tel.
cat city 92234 326'=2681-
State Lic. City
& Classif. Lic. # 14 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed%under provisions of-Cti-apter=g,(commencing with Section
7000) of Divisi n 3 oo*,,rthe—B,ussii ess and Professions Code, and my license is in full force andy
effect.—u `!
_SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirin that I am exempt from the Contractor's License Law for the following Ah
reason: (Sec. 7031.5,Busbmess and Professions Code: Any city or County which requires au
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ole a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the applicant to a civilpenalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 134-55
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. a�
Professions
Code: The Contractor's License Law does not apply to an owner of property who •
00
WNW or improves thereon and who does such work himself or through his own employees, Mech. ,24' 00
provided that'such kmprovements 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 Electrical
of proving that he did not build or improve for N30-00e purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 27.00
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 S.M.I. 1.40
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Oam exempt under Sec. B. & P.C. for this reason Grading
'• Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION I
I hereby affirm that I have a certificate of consent to self4risure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof_ (SkS ec? 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. r
TOTAL
CERTIFICATE OF EXEMPTIONFROM
WORKERS'COMPENSATION INSURANCE REMARKS i Ci
(This section need not be completed if the permit is for one hundred dollars (S100) valuation
or less.)
I certify that in the performance of thg 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
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 Provsions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INSPECTOR
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. 6"15"'89
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
(FINAL
DRAINAGE PIPING
CAR P. SQ. FT. @
GROUT
WATER HEATER
DRINKING FOUNTAIN.
WALL SQ. FT.
BOND BEAM
WATER SYSTEM
URINAL
SOFT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
(9REMARKS:
(/!/
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® Vic
HOUSE SEWER
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
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.
FRAMING
FINAL INSP.
ROOFING
(9REMARKS:
(/!/
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL