04804 (MFD5)Qum&
ID4804
P.O. BOX 1504
Building 5.i" 3616 Firestone 78-105 CALLE ESTADO 1
Address LA QUINTA, CALIFORNIA 92253
Owner
Sunrise Company
Mailing BUILDING:'TYPE CONST. OCC. GRP.
Address 75-005 Country Club A.P. Number PGA Wiest, The Groans
CityZip Tel. .
Palm �3eser 92250 568-► 92€3 Legal Description
Contractor Project Description ase BBC. plan E
Address
City Zip Tel.
T y
State Lic. City
& Classif. 288130 Lic. # -32.3 > r ,y Sq. Ft.. _ 170 No. , . , No. Dw.
Arch., Engr.,
Size Stories Units
.
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
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. -{, �..: + i rf -r" 1 / ?',, +-
SIGNATURE - DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $120069
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 o/ the Business and Professions Code, or thathe 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 not more than five hundred dollars ($500).
21
O 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.► • 1r.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 4E15 • 5U
Professions Code: The Contractor's License Law does not apply to an owner of property who st �s tf i�1
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 q y�1 �•
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.) y ti C tf
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 105 .05
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law tip
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. - V ♦ 44
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure $2017.31 X17.31 l fl, 3a3 » b i
Lass Credit ir3!$8•6b
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
0 Copy is filed with the city. ❑ Certified copy is hereby furnished. -
TOTAL �ii�4 r � Jf � • 3 x>� � 74..i. /
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation tlSi[iz!1}Tit y;'i'€+4t•-7.1:!"eaR)�"Itk '.�•7 }1�
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INS/PECTOR
expiration if work thereunder is suspended for 180 days. 7 S/ a
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant ' Date
Mailing Address Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN -,BUILDING, GOLD NROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT y S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. t$
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. a
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. I SO FT. 9
FINAL INSP.
WALL SO. FT. 41
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ -Plus-x$-=$
URINAL
SO FT rd
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.000L HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNORYTRAY
AIR HANDLING UNIT CFM
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.
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 g 2Vc
HOUSE SEWER
AL 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
GA (FINAL)
TEMP. POLE
GROUT
WATER HEATER
VICE si�
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
INSULATION/SOUND
FINISH GRADING
AL INSPECTION
CERT. OCC,
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 71