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04677 (MFD5)4�u� 177 P.O. BOX 1504 Buildings 78-105 CALLE ESTADO Address 55-096 r1j• 0stane LA QUINTA, CALIFORNIA 92253 Owner Mailing ,iunri.ae Company BUILDING: TYPE CONST. OCC. GRP. Address 75-005 Country CluLe A.P. Number PGA West The Greens City Zip Tel. Palm Desert 92.260 5150-2823 Legal Description Contractor Nation%! Mortgage Project Description pt1+Sse 6G "' }?lo" rin Address ='ifliifM+ City Zip Tel. State c. City & Cla sl f. Lic. # - ��"�� 39 Sq. Ft. 53 a No: No. Dw. Arch., Engr., Size Stories Units Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. 1 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 Estimated Valuation 011 f 5 reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior do its issuance also ' requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars ($500). O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.i do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. Professions Code: The Contractor's License Law does not apply to an owner of property who 49,00 builds or Improves thereon and who does such work himself or through his own employees, Mech. provided that such improvements are not intended or offered for sale. If, however, the building �fr�.i or Improvement is sold within one year of completion, the owner -builder will have the burden Electrical V9 • X2 of proving that he did not build or improve for the purpose of sale.) c� �t 'y ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 91 •� 00 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. 7.60 such projects with a contracf0r(S) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. 8 P.C. for this reason Grading Driveway Enc. Date Owner Infrastructure V21$4 1 1� I u 1 Cs" E!:7 WORKERS' COMPENSATION DECLARATION 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 ❑ Copy is filed with the city. O Certified copy is hereby furnished. TOTAL 'A 4�4 r-J;�t}- Jr+A CERTIFICATE OF EXEMPTION FROM REMARKS F WORKERS' COMPENSATION INSURANCE e (This section need not be completed if the permit is for one hundred dollars ($100) valuationj'1�1 {tv„7A.� lj!?rR',q�tti-•F7^''".f;A L'� d� or less.) W .. 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. If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions or the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line 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 Setback from Property Line Lender's Name Lender's Address FINAL DATEINSPECT R This is a building permit when properly filled out, signed and validated, and is subject to �} � IR expiration if work thereunder is suspended for 180 days. 1 certify that I have read this application and state that the above Information is correct. Issued by: Date Permit 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. Validated by: Signature of applicant Date-- Mailing ate Mailing Address Validation: City, State, Zip 1 FINANCE, PINK - APPLICANT, GREEN -; BUILDING, GOL09WROD-.&SSESSOR.S OFFICE, -HARD COPY.- FILE . . -.-. CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES tST FL SO Fl (a S UNITS SLAB GRADE ROUGH PLUMB BONDING Y YARD SPKLR SYSTEM 2ND FL SO FT. qt FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FTa G (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. * TEMP. POLE GROUT DRAINAGE PIPING CAR P. SO FT. IQ FINAL INSP, WALL SO FT. rd WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. $ -Plus-x$-=$ URINAL SO FT /B FINAL INSP. FRAMING ESTIMATED CONSTRUCTION VALUATION S WATER PIPING NOTE: Not to be used as Property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTOXDISH I APPLIANCE DRYER FIRE ZONE ROOFING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIREPLACE LAUNDRYTRAY AIR HANDLING UNIT CFM 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. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ I'A c SEWAGE DISPOSAL SO.FT.GAR ig 3/4c HOUSE SEWER INAL INSPECTION 54 ./ 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 8 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. G (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL (FINAL) / c TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP, BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-x$-=$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR. GAR. FIREWALL LATHING MESH INSULATIONISOUND FI SH GRADING INAL INSPECTION 54 ./ 7E�RT::0:CC FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL