05094 (SFD)1� 4"
Z-Z�-
Building
Address
Owner
Mailing
Address
City
4
P.O. BOX 1504 No. 05094
54-348 S3. oal Creek78-165CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 ...
R
Sunrise -Company
BUILDING: TYPE CONST. OCC: GRP. -
42 -600 lyock St. Suite: 200 A.P. Number FGA West — Phase 29A
Contractor
Address
Tel.
568—
Tel:
State Lic.City
& Classif. 2$$13€3 Lic. # 328
Arch., Engr.,
Designer
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
700()) of Division 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNEWBUILDER DECLARATION
I hereby affirin that 1 am exempt from the Contractor's License Law for the following
�* reason: (Sec. 7031.5,Bushm and Professions Code: Any city or county which requires a
Permit to construct, ader, irprove, dernafish, or repair any structure, prior to its issuance also
requires the applicant for such permit to Ide 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 civ9 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 Conhactor'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. ll, however, the building
orimprovernent is sold .within one year of completion, the owner -budder wid have the burden
of proving that he did not build or irprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to com
• struct the project (Sec. 7044, Business and Professions Code: The Contractors 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) dcensed 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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be comIA1ated if the permit is for one hundred dollars ($100) valuation
or less.) - -
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California. -
Date owner
NOTICE TO APPLICANT: 8, after making this Certificate of Exemption you should become
subject' to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this Permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Legal Description
Project Description Plan 2V
Sq. Ft. 154$
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolitioi ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
C,
Const.
G O
Mech.
AA nrt
Electrical
A h
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
9 A.A
nA+
�..
TOTAL
9 A "
. 7) 1-1
REMARKS
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
Issued by:
Datet 2 ` 2 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
G S (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT. ®
=$
LUMBER GR.
FINAL INSP.
URINAL
SQ. FT. @
OOFING S
ESTIMATED CONSTRUCTION VALUATION $
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, TEM/PERM
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_
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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 R 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.
G S (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
AS (FINAL) `
TEMP. POLE
GROUT
WATER HEATER
a4WCE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
RAMING
FINAL INSP.
OOFING S
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR.
/,FIIRR/E�WALL
LA 1 G jkt
MESH
NISOUNUcd
FIN H GRADING
INSPECTION 62
ll��
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL