06010 (SFD)Building
Address
Sunrise Co.
Mailing
Address 75-005 Cotmt ry Club
City T92260
P.B.
Contractor
s4attte
Address
City
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 0601-3
BUILDING: TYPE CONST: OCC: GRP. -
A. P.
RP.A.P. Numbert '
Tel.
54-282$ Legal Description
Project Description hit"ISR Pitktt! 4M
State Lic.I City
& Classif. ftnn. ,^ Lic. #
'Address I Tel.
city( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70pf)) 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,Business and Professions Code: Any pity or county which requires a
Permit to construct, after. 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'5censed pursuant to
fhe provisfons o/ the Contractor's license Law, Chapter 9 (commencing with Section 7000) of
Division 3 01 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 two hundred doears ($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 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 knprovements are not intended or offered for sale. N, however, the building
or improvement. is sold within one year of completion, the owner-Duider will have the burden
of proving that he did not build or improve for the purpose or safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to Cori-
struct the project (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or krproves'thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractors License Law.)
❑ .I 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
Worker's 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 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: If, after makhg 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.)
Lender's Name
Lender's AddI. ress
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 Address
City, State, Zip
Sq. Ft. No. No. Dw.
Size 3142 Stories Units
NewXX Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 215,834-00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
AMOUNT
Plumbing ZIUVOU
S.M.I. M
Grading
Driveway Enc.
Infrastructure_
i�t3" isle: t aB 8.13
Yitra 4 . 3
TOTAL �►�. J r'r fs 1r`.
REMARKS'rs:,-d
:syr,,.. .P •'drtr.i .y... f.. .. r r.w' i e. ., , ..
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
b
FINAL DATE
INSPECTOR
6_19-49
Issued by:
Date Permit
Validated by:
,Validation:
' CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. @ $
UNITS
XS!B GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
�
FORMS
ER OR SEPTIC
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
AS (ROUG
METER LOOP
GAR. SQ. FT. @
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. @
GROUT
WATER HEATER
WALL SQ. FT. @
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ FT @
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
RAMING11 ,
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
REMARKS:
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
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.
SO. FT. @ c
BATH TUB
MES
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/. c
SEWAGE DISPOSAL
FINISH GRADING
SO.FT.GAR @ 3/ac
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
ROUND PLUMBING'►
ZA
UNDERGROUND
A.C. UNIT
COLL. AREA
XS!B GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SEPTIC
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
OUND. REINF.
AS (ROUG
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FINAL INSP.
RAMING11 ,
NAL INSP.
,
00FING / �,/J
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAJ. FIREWALL
19G
MES
CATION/SOUND /! 2
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESI NITIALS
GARDEN WALL FINAL