08017 (SFD)TAh
P.O. BOX 1504 No. 08017
Addressg . 55-341. iged Foolt_ LA QUINTA, CAL FORNIA 92253..
Owner `
Stmrise. Conwany BUILDING; TYPE.CONST. - '• OCC: GRP.- ,r °
Mailing : .. .�
Address' 2�� Cci®£'_ S�t ee�y SE4� 2a A.P. Number PGA West
;City 11Zip; r Tel.
Pa
1 5e 92260- 58-2828 Legal Description • Tract 255013-2
'Contractor 3UbR
Project Description Q�#�5e P�+3Si
-National land & ort ace
Address .
City Zip Tel.:
"State Lic. City r
& Classif. 2MI30 - Lic. # 323 Sq. Ft. 2129 No. No. Dw '
Size ` Stories Units
Engr., - ,
J: Designer New O Add 0' Alter ❑ Repair O ` Demolition O ►
:.Address. Tel.
ity Zip State
Lic. #
IN
's •;•, - ,' •, " : "y LICENSED CONTRACTOR'S DECLARATION -
I hereby afhrm'that Iam licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business afid Professions Code,, and my license is Ln,full,fordb and
effect V1 ;'; •I!
?*I SIGNATURES' R - .? DATE
OWNElf-BUILDER DECLARATION Estimated Valuation
~+
['hereby affirm that I am exempt from the Contractor's License Law for the following tjj ' 4
"reason: (Sec.. 7031.5,Business and Professions Code: Any .city or county which requires a • C �+
'permit to construct, alter, 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 PERMIT . AMOUNT' - -••p}
f
.=visions 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 plan Chk. De
for the alleged exemption. - Any violation • of Section 7031.5 by 'any applicant for a permit p +.
;.subjects the applicant to a civil penalty of n><Dot more than five hundred dollars (8500). 1R 2
..`.:0 I, as owner of the property,.or my employees with wages as their sole compensation, will Plan Chk. Bal. c62���..,eT
- do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. i7JLwW/
".:.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; s� . Mech. W .00
r- `provided • that such improvements are not intended or offered for sale. If, however, the building ' t s
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.) qq C�
', S .0 I; as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 1201 W
_ 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 S.M.I.-
F ; such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
' Grading • -,
O I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
(Date owner Infrastructure TMb. 80 113 f? .�
WORKERS' COMPENSATION DECLARATION ' • i '
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
- O Copy is filed with the city. O Certified copy is hereby furnished. t ' >
TOTAL
` CERTIFICATE OF EXEMPTION FROM REMARKS
1"'e'
WORKERS' COMPENSATION INSURANCE F e t r, y._ < sy ..L3Rr d �r ! t < ~ Y �dt i
_
(This section need not be completed if the permit is for one hundred dollars I'S 100) valuation:• • - ""'4.,.f�i.��`�'�'°' '
•. or less.) - -
I certify that in the performance of thg work for which this permit. is issued, I shall "riot
employ any person in any manner so as to become subject to the Workers' Compensation,
Laws of California.
•4 NOTICE TO. APPLICANT:r If, after making. this Certificate of .Exemption you should become ' ZONE: - BY:
- subject to the 'Workers' 'Compensation provisions o/; the Labor Code, you must forthwith' a,.;
comply with such provisions or this permit shall be deemed revoked. - - Minimum Setback Distances:
Front Setback from Center Line -
` Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY. Side"Street Setback from Center Line
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:) Side Setback from Property Line
Lender's Name -
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days. c /e� Spm
I certify that I have read this application and state that the above information is correct. Issued by: Date a/ C / 94lPerfTlit
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.., s
mentioned property for inspection purposes. Validated by:
3 .
r.
Signature of applicant Date -
Mailing Address Validation:
City, State, Zip
t �
n� s r /� { 4 'y'�YI :...�xr .tri � �: i � � �. c .,i i-�'�re r .-1- 'C :vr'q '1 • f ii(.,. '!"?' .;w a: ��.�.t ar. _'-.y ."R�t�a ;s
s t ri•'.'i'' ,. yv r+� r �� i F a'��.K i s . 4 r ? '� <t 'tv�"•F - 1-c'R �+ r � ,; S F � � � r -E 4f
g>aJ ..;},� y;,as y'„s�":•�< �. 5� �.k. 4 -v 4 l - �-: s�;:� x. 4. • q ",-rah .� �j, a. �i` .r.. ,� v[ �..sf•y-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN,
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
REMARKS:
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
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.V�
6
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL