06002 (SFD)T4hf 4 4 a"
Building j�, 035 Southern 3iUs
Address
sunrise Co.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-005 Country Club
City Zip Tel.
F.D. 92260 1 568-2828
Contractor
Zip I Tela
State Lic. City
& Classif. 288130 Lic. # 328 .
Arch., Engr.,
CJesigner • '
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
7000) 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. 7031.5,13usiness and Professions Code: Any city 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 rile 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 civil penalty of not more than five hundred dollars (S500).. -
❑ 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 bnprovements 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
of proving that he did not bulld 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 or 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. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I heieby 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 (8100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ anyperson 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
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
Ihereby 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 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. 0,60-02
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number prA W69t
Legal Description
Project Description Phase 19B Pl= 20M
Sq. Ft.. 2596 No. No. Dw.
Size Stories Units
New)M Add ❑ Alter ❑ Repair ❑ Demolition ❑
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front.Setback from Center Line
Rear Setback from Rear Prop. Line
Estimated Valuation
Side Setback from Property Line
PERMIT
FINAL DATE
AMOUNT
Plan Chk. Dep.
Issued by:'
Plan Chk. Bal.
Validated by:
%;.
Const.
Validation:
M.30
Mech.
040W
Electrical
134.33
Plumbing
>J.cJU
S.M.I.
•
Grading
Driveway Enc.
Infrastructure
TOTAL
I +
...% .•/_°5141
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:'
DatePermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
B GRADE
ROUGp PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
R OR SE/�PTI
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
/�
AS (ROUGHY . /„ V
`�
METER LOOP
HEATING (FINAL)
POWER OUTLET
DRAINS
GAR. SQ. FT. @
TEMP. POLE
IROOF
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SQ. FT. ®
_$
LUMBER GR.
FINAL IN22,_Z�K]
URINAL
SQ FT a
OFING
6Mt2
ESTIMATED CONSTRUCTION VALUATION $
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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
IKITCHEN 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.
SQ. FT. ® c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID a 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
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
' BACK
ND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE
ROUGp PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
R OR SE/�PTI
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
/�
AS (ROUGHY . /„ V
`�
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL Ll
GAS (FINAL))
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL IN22,_Z�K]
G /(/(
INSP.
OFING
6Mt2
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G6VFIREWALL
ING 2,.�tS
MESH
TION/SOUND l�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL