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04810 (MFD5)4 P.O. BOX 1504 Building 55-534 Fi r, OStOne78.105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner r. Sunrise Company BUILDING: TYPE CONST. OCC. GRP. A.P..Number ,.. PGA east — The ia:Cllens Legal Description Project Description Phase 88G "' rlin3 Ad _ Mailing «� Address !:/'" 005 Country Club ~. City Valli Desert Zip 92260 Tel. Contractor National xortf:'?aacl Address Mech. City Zip Tel. Plumbing State Lic. & Classif. 288130 City Lic. # 320 � Sq. Ft. _ 1312 No. No„ Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. Infrastructure P� City Zip State Lic. # 4-' 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. ;r; r' //C y ,+1 f , , 5.. s ; i /r7 f -r r 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, alter, 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 thathe is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjcts the applicant to a civil penalty of not more than five hundred dollars ($500). 01, 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 contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 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 O 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 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 California. Date Owner NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become subject to the Workers' Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shell be deemed revoked. Estimated Valuation $95 * 217 PERMIT Plan Chk. Dep. I hereby affirm that there is a construction lending agency for the performance of the Plan Chk. Bal. Const. Mech. Lender's Name Electrical Plumbing FINAL DATE S.M.I. This is a building permit when properly filled out, signed and validated, and is subject to Grading Driveway Enc. Infrastructure P� ;An cracer U i 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- TOTAL A i • AMOUNT s 4 d7.0v REMARKS IT 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 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. y � I certify that I have read this application and slate 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 Address Validation: City, State, Zip WHITE - FINANCE, PINK - APPLICAN , GR EN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE .L FEES NO. PLUMBING FEES YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING FLOOR DRAIN WATER SOFTENER WASHER(AUTOYDISH) GARBAGE DISPOSAL LAUNDRYTRAY KITCHEN SINK WATER CLOSET LAVATORY SHOWER BATH TUB WATER HEATER SEWAGE DISPOSAL HOUSE SEWER GAS PIPING PERMIT FEE ELECT. FEE SMI FEE PLUMB FEE 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./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER RVICE �� FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-X$ =E LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR - GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL