04656 (MFD5)Tit,, 4 Q"
04556
P.O. BOX 1504
.Building' 78-105 CALLE ESTADO
=Address• 55-202 Pirestone LAOUINTA,CALIFORNIA 92253
'Owner ^
''"Sutwise 'Comma ny'Mailin
Address_ ',75-005 Country Club
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number -PGA Wast --The Greens
~
� City., "; •' Zip Tel.
r y., I�esg7Ct 92260 56i-2828
Legal Description
Contractor.
National Mortgage
Project Description
�
Phaso SAG Plan CR
Address,, ,
PrK
-Salmi
City }" t Zip Tel.
State Lic.'"
& Classif.- ` � ��
City 398
Lic. #
14,00
Sq. Ft.
2
No. No. Dw.
Size
Stories Units
Arch.,,Engr.; '
Designer ,
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City 1
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) lot Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
-I hereby affirm.that.1 am exempt from the Contractor's License Law for the following
reason: (Sec:l7034.5,Susiness 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 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 o/,fhe 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 five hundred dollars (E500).
O 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 or property who
builds or improves thereon and who does such work himself or through his own employees,
provided that suchimprovements 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 con-
slruct 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
Estimated Valuation
0110,574
PERMIT
'
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.380.97
Const.
460.50
Mech.
39.00
Electrical
j�$ �$()
Plumbing
99.00
S.M.I.
7.74
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
Grading
Driveway Enc.
Date' Owner
Infrastructure
$;Z,407.92 . 24 w 9.-t
Leas Lrea l.'t 1 fAgJ* %0) *A
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.
i
TOTAL
f+ +=" w `� "l "N C-4CI 0,-
k 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.)
1 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 Cali ornla. •
REMARKS
trn'}� :'iC.�±�kyc'
Date • Owner
NOTICE1TO APPLICANT: If, 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.
ZONE: BY:
Minimum Setback Distances:
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
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.
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.
FINAL DATE
Issued by:
Validated by:
INSPrECTO
1 %�
NSP 1T / �{
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City; State, Zip
GOLDENROD - ASSESSOR'S
OFFICE, HARDC PY - FILE
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (a S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. ilr
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. I SO FT. 4V
FINAL INSP.
WALL SO. FT. @
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
y -plus-x$
.S
URINAL
SO. FT. g
FINAL INSP.
FRAMING
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
WASH ER(AUTOXDISH)
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. g& c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 144 c
SEWAGE DISPOSAL
SO.FT.GAR re 3/4c
HOUSE SEWER
FINAL INSPECTION`(
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.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
y -plus-x$
.S
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
F NISH GRADING
FINAL INSPECTION`(
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL