05993 (SFD)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 55-089 r4xxtbarn Rills LA QUINTA, CALIFORNIA 92253
Owner
Sunrise Co.
Mailing
Address -
City Zip+ Tel.
P.D. 92260 568-2828
Contractor
>�tttfw
Address
City
State Lic. City
& Classif. 288130 Lic. # 328
Arch.; Engr.,
D•e'signer-,�' `
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
1 hereby affirin that I am exempt from the Contractor's License -Law forthefollowing
reason: (Sec. 7031.5,6usiness and Professions Code: Any city or county: which requires a
permit to conshuct, atter, 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 703 1. 5 • by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars (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, 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 Improvements 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 build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to com
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of properly 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 hereby affirm that 1 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. O 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 (5100) valuation
or less.)
I certify that in the performance of the 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: fl, 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
1hereby 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 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 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
No. 05393
11LDING: TYPE CONST. OCC: GRP.
P. Number PGA West
!gal Description
Project Description Pls,8se 19B PlAn IDN
Sq. Ft. 2272 No. No. Dw.
Size Stories Units
NewXX Add ❑ Alter ❑ Repair ❑ Demolition ❑
REMARKS
`C u G".S" 1 t U is "L, 1 i 4.3 . oy
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: Date 6-19-89 Permit
Validated by:
Validation:
Estimated Valuation
15$ 646.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
704.27
Const.
846.00
Mech.
82.50
Electrical
123.02
Plumbing
192.0
S.M.I.
11.13
Grading
Driveway Enc.
Infrastructure
3569.53
Y _
1784. 77'
Intra e
1784.77
TOTAL
3743.69
REMARKS
`C u G".S" 1 t U is "L, 1 i 4.3 . oy
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: Date 6-19-89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
DUCT WORK
ROCK STORAGE
ND. REINF.�CaAS
Cl
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT.
_Ku
REINF. STEEL
GAS (FINAL) TEMP. POLE
POWER OUTLET
ROOF DRAINS
GAR. SQ, FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRAINAGE PIPING
CAR P. SQ. FT. ®
LOMB R GR.
�j(LFINAL INSP. /
v
MING 2�
FINAL INSP.
DRINKING FOUNTAIN.
WALL SQ. FT.
REMARKS:
REMARKS-
URINAL
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
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(AUTO)(DISH)
APPLIANCE DRYER
IGARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
MES
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 ® 1% c
SEWAGE DISPOSAL
FENCE FINAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
GARDEN WALL FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE tL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
15FIlACK
NO PLUMBING % UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
F MS
ER OR SEPTI ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF.�CaAS
Cl
(ROUGH) L- — METER LOOP
�%
HEATING (FINAL)
OTHER APPJEOUIP.
_Ku
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
j plus x$
-$
LOMB R GR.
�j(LFINAL INSP. /
v
MING 2�
FINAL INSP.
PING
• 1r �
A-1
� 11
REMARKS:
REMARKS-
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MES
A—SULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1