04657 (MFD5)04657
v` . •, c ' P.O. BOX 1504
'.Building.�l i4'2 , FirestonQ LA QUINTA, CALIFORNIA 92253
" Address,
Owner `
Su'nrUm Com, any
:IMailing. Address;,' T —005 CaixXi.3'ry
y -City. •` Zip
'Pa ti 3 eIIt? t 922€0
Contractor
?3ational mortgage
Address
Sam
City -. Zip Tel.
State,Lic.-�� City$
& Classif. Lic. #
Arch.,,Engr:;
Designer
Address-T"C! ' Tel.
City Zip State
4ty;;fs - Lic. #
LICENSED CONTRACTOR'S DECLARATION I r
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. .w �,- :F;�r • i r�i
SIGNATURE DATE
1
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec., 7031.5,Buslness 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 of4pe 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 ($500).
❑ 1, 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
bullds.or improves, thereon and 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."hin 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.)
O I, as owner of the pr-operty, 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
4 such projects with a contractors) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. 8 P.C. for this reason
Date Owner
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. ❑ 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 ($100) 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
w Laws of California.
` Date _"_' • Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to l 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 FINAL DATE INSPECTOR
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. Issued by: Date Permit
1 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 Address Validation:
City, State, Zip
.y
•'� t,' WHITE -FINANCE, PINK: APPLICANT, GREEN -BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY -FILE
11LDING: TYPE CONST. OCC. GRP.
P. Number PGA Wast — The Greens
Description
t Description Ph4ae 8AG — Plan FR
Sq. Ft. •„r 1700
New ❑
Add ❑
No. ^" No. Dw.
Stories Units
Alter ❑ Repair ❑ Demolition ❑
$x,20, 69
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
401.27
Const.
405.50
Mech.
39.00
Electrical
72.50
Plumbing
105.00
S.M.I.
8.44
Grading
Driveway Enc.
Infrastructure
$2017.31
1059.66.
amass Credit
1.358.56
TOTAL
REMARKS
vj7:71t4A5gi°► il-40f
toy v -it -i7J, i] 1Lt
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
ELECTRICAL FEES
NO. PLUMBING FEES
UNITS
A.C. UNIT
COLL. AREA
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
FORMS
DRAINAGE PIPING
ROUGH WIRING
DRINKING FOUNTAIN
ROCK STORAGE
URINAL
GAS (ROUGH)
WATER PIPING
HEATING (FINAL)
FLOOR DRAIN
REINF. STEEL
WATER SOFTENER
SIGN
WASH ER(AUTONDISH)
GARBAGE DISPOSAL
WATER HEATER
LAUNDRYTRAY
FINAL INSP.
KITCHEN SINK
TEMP USE PERMIT SVC
WATER CLOSET
POLE, TEMIPERM
LAVATORY
AMPERES SERV ENT
SHOWER
SO. FT. ®c
BATH TUB
SO. FT. @ c
WATER HEATER
SO. FT. RESID a 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/.c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
EE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
ICAL 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.
$ plu5 x$
c $
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIQN l
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL