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04802 (MFD5)• �� `wry 48 P.O. BOX 1504 , Building 78-105 CALLE ESTADO Address 55-444 Firestone LA QUINTA, CALIFORNIA 92253 mauing Address 75-005 Country Club City Zip Palm Desert 92260 Contractor National Mortqaqe City Tel. BUILDING: TYPE CONST. OCC. GRP. A.P. Number, PGA V -109t - The Greens 568-2828 Legal Description_ Project Description State Lic.288130 y� 8 Classif. (City Lic. # Arch., Engr., Designer 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 SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason: (Sec. 7031.5,Business 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 of the 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). ❑ 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 of property who builds 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 orimprovement 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- 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 such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. & 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 (8100) 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 Laws of California. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption youshould become subject to the Workers' Compensation provisions o/ 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 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. Vali ated by: Sibnature of applicant Date Mailing Address Valid tion: City, State, Zip WHITE - FINANCE, PINK - APPLICANT, GREEN, BUILDING, GOLDE OD - ASSESSOR'S OFFICE, HARD COPY - FILE rhaso #SDG w Flan D Sq. Ft. w No.. Size 1700 Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $120o769 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 401.27 Const. 41�15.5V Mech. 39 . OU Electrical 72.50 Plumbing 103.00 S.M.I. 8.44 Grading Driveway Enc. Infrastructure $2017.31 i 358 • b LOSS creta t 1J3`32$.bb TOTAL *21470.37 REMARKS N5 illrl * -;1?rah'Ai 47-Rtt-n. -4 10 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 FINAL DATE I S1P7.1CTT17 t, Ell Issued by: Date Permit CONSTRUCTION ESTIMATL NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT rp 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 SC! F-t a GAS (ROUGH) METER LOOP HEATING (FINAL) POWER OUTLET ROOF DRAINS GAR SO. FT. a TEMP. POLE GROUT DRAINAGE PIPING CAR P. 50 FT. 4V FINAL INSP. WALL SO. FT. WATER SYSTEM DRINKING FOUNTAIN GRADING cu. yd. 1 plus xE =$ URINAL SO. FT. (a FRAMING FINAL INSP. ESTIMATED CONSTRUCTION VALUATION S WATER PIPING NOTE Not to DR used as property tax valuation REMARKS: FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ERIAUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM SPARK ARRESTOR 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 INSULATIONISOUND SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1'A c SEWAGE DISPOSAL SO.FT.GAR r 3/4c HOUSE SEWER r CERT. OCC. GAS PIPING PERMIT FEE FENCE FINAL PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE EPL.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 APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER VICE S•�[ FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. 1 plus xE =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FI ISH GRADING NAL INSPECTION i) V r CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINiTIALS GARDEN WALL FINAL