05995 (SFD)P.O. BOX 1504 No .. 0599.5
Building ti `+ 78-105 CALLE ESTADO
Address �>xt
LA QUINTA, CALIFORNIA 92253
Owner
SL�nrise Co. y
�Mailin BUILDING: TYPE CONST: -0CC: GRP. °y•
Address 5--005 Co—antrv. there J A.P. Number ,P" U'L"S$
City lZip Tel.,
� _ LE& r
Contractor
.Address .
City lZip
z Legal Description
L rte. -2i '
Project Description ' • '.P18Se 19, i'U-a 2W
•SJ
.State Lic. City
4Classif. 28$130: Lica# 328..,.,, �.r
Arch., Engr.,-
.,.Designer.
�'.
Sq. Ft.
•Size.. - -•,
No. No. DIN.
-Stories - Units k • ".
'
New !D • Add 0
.. Alter 0 Repair O .-Demolition El
Addr6ssy =k
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section
TO j of Division 3 of the Business and Professions Code, and my license is in full force and
effect. r
• • ' '
'
,
SIGNATURE DATE
OWNEWBUILDER DECLARATION
" 1 herebyraffirTn that I am exempt from the Contractor's License Law for the following •.
reason: (Sec. • 7031.5,Business and Professions- Code: Any city or county which requires a
Estimated Valuation
-}
4 p ca
PERMIT..,
.� - •'
AMOUNT
permit to construct, after,.bprove, 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 7031.5 by 'any applicant. for a permit
I subjects the applicant to a cin? penalty of not more than five hundred dollars ($500).
0 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
Plan Cihk. Dep.
,
Plan Chk. Bal.
l •• 17
Const.
Mech.
-
builds or improves thereon and who does such work himself or' through his own employees,
I provided Nat such Improvements are not.intended or offered for sale. If, however, the building
Electrical
134 - - •-
-
of improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he d_id not build or. Improve for the purpose. of sale.)
Plumbing
498.IND . ^
O 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 contractors) licensed pursuant to the Contractor's License Law.)
� ❑ I am exempt under Sec B. & P.C. for this reason
'
S.M.I.
Grading
_
Driveway Enc.
,
Date Owner
Infrastructure_0-(.�.�
c{
Less
=22 .1V5
WORKERS' COMPENSATION DECLARATION
In, Dula
,• - 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
0 Copy is filed with the city. 0. Certified copy is.hereby furnished.
TOTAL
„
4
CERTIFICATE OF EXEMPTION FROM. -
t WORKERS' COMPENSATION INSURANCE
is section need Trot be
mor ess; completed it the permit is for one -hundred dollars (5100) valuation
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
REMARKS
'
inafr°^>• f r^ �^=-�'�R L r:1fJ
Li? r "Cfi+!wY 1 t T•! 3 kTii x Y X a s e ..
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
complywithsuchprovisionsorthispermitshallbedeemedrevbked. - -
ZONE: _
,'Minimum Setback Distances:
BY: -
-
Front Setback from .Center Line'- ^'
•Rear Setback from Rear PropiLine � �= '•
coNsrRucnoN 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.)
Side Street Setback from Center Line
Side Setback from Property Line `U
Lender's Name
FINAL. DATE
ISSUed y:
\
Validated by:
•_
INSPECTOR
Date Z-Pefmlt ` - -
t
a
'
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 I.have read this application and state that the above information is correct.-.
t Lagree 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
Validation: \
+ .
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
GH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
-0 FORMS
/EWER OR SEPT
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
AS (ROUGH) ,/ A
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN.
WALL SQ. FT. Q
=$
LUMBER GR.
FINAL INSP.
RAMING
URINAL
SQ. FT.
O/:,:
/` f
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAR. FIREWALL
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.
SQ. FT. ® c
BATH TUB
FINISH GRADING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
SQ.FT.GAR ® VAc
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
OLIND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
GH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
-0 FORMS
/EWER OR SEPT
ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF.,
AS (ROUGH) ,/ A
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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.
RAMING
FINAL INSP.
FING 2„A
O/:,:
/` f
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
RING
MESH
NSULATION/SOUND /�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESfINITIALS
GARDEN WALL FINAL