06011 (SFD)44
P.O. BOX 1504 N o . 06011
Building 78-105 CALLE ESTADO
Address 55-143 Southern hills LA QUINTA, CALIFORNIA 92253
Sunrise Co.
Mailing
Address 75.005 Country Club
City Zip Tel.
F.D. 92253 568-2828.
Contractor
same
ty - lZip I Tel.
State Lic. I City ,
& Classif.. 28813C Lic. # 328
Designer
Address Tel.
City lZip I State
Lic. #
u 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 affirm that I am exempt from the Contractor's License Law for the following
• reason: (Sec. 7031.5,Busbness 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 rive hundred dollars ($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 Contractors License Law does not apply to an owner of property who
builds or Inproves thereon mid 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.)
❑ 1, 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 of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 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-insuie, 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 the 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: ft, 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.)
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 cerlify 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
)ILDING: TYPE CONST. OCC: GRP.
P. Number PGA West
,Legal Description
Project Description
Phase 19B Platt 40H
w
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft. 3142
Size -
No.
Stories
No. Dw.
Units
New a Add ❑
Alter ❑
Repair ❑ Demolition ❑
Issued by:
Date Permit
Validated by:
-
Validation:
- _
Estimated Valuation
215,834.40
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal
859.03
Const.
1045.50
Mech.
.$2 . 50
Electrical
153.47
Plumbing
210.00
S.M.I.
15.12
Grading
Driveway Enc.
Infrastructure
4856.26
iris Credit
2425.13
Intra Due
x ►z s>: s
TOTAL
'►. a
6� r
REMARKS �:~s«-...�,. v1x,^'�.^k1 CA4%1•. �r1
'yYfw M3'-- :1 r W';. VZ7 t .. sK i
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 Permit
Validated by:
Validation:
- _
+ CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
LAB GRADE
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
UND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. STEEL
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
DRINKING FOUNTAIN.
WALL SQ. FT.
FINAL INSP.
BOND BEAM
URINAL
SQ FT ®
GRADING
cu. yd.
$ plus x$
_$
ESTIMATED CONSTRUCTION VALUATION $
NSP. -
FINAL INSP)-_-.
WATER PIPING
NOTE: Not to be used as property tax valuation
OOFING jC
FLOOR DRAIN
MECHANICAL FEES
C'l G`
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
KITCHEN SINK
ABSORPTION SYSTEM B.T.0
I ITEMP 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.
SO. FT. RESID ® 1V4 c
SEWAGE DISPOSAL
SQ.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 iPLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
LAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
UND. REINF.
AS (ROUGH) �/`2
!\
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LU M ER GR.
NSP. -
FINAL INSP)-_-.
WVXVING
FINAL INSP.
OOFING jC
v
n �t
C'l G`
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING ems- Q �� 1
M SH
�1SULATIONISOUND
GGG
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlIYITIALS
GARDEN WALL FINAL