05086 (SFD)4
050
P.O. BOX 1504 N Q , 86 ~
Building 78-105 CALLE ESTADO
Address 54-575 Inverness '"n LA,QUINTA,,CALIFORNIA92253
Owner '
Sunrise- Go�tany -
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address
42-600ok Ift siiff A.P. Number POIA Water — ;ahyino 7QA
City Zip Tel.
Legal Description
Contractor
Project Description �elt .� atm
Address
Llp I el.
State Lie. City
& Classif. 288130 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
ISq. Ft. 1627 No.
Size' . Stories
City Zip State
Lie. #
" LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
71100) of Division 3 of the Business and�Professions Code, and my license is in full force and
effect.' .i , .�r r' f , r • __ � } 1 . � r `, f
` SIGNATURE `- - DATE
OWNER -BUILDER DECLARATION
I hereby affirdn that I am exempt from the Contractors License Law for the following
reason: (Sec. ,.703T.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
:requlres�theappficant for such permit to rile a signed statement that he is licensed pursuant to
provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
.` Division 3 of the Business and Professions Code, or that. he is exempt therolrom, and the basis
- � Ihr 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 rive 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 inproves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. It however, the building
or improvement is sold wither one year of completion, the owner -builder wig 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
Workers 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 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' 1 i , _..
%Owner a..,....:s
NOTICE' TO APPLLCAM: ft, 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.
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 car ity that I have read this application and state that the above information is correct.
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.
Signature of applicant Date -
Mailing Address
City, State, Zip
No. Dw.
Units,
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
113,727
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
380.44
Const.
468.00
Mech.
34.00
Electrical
67.41
Plumbing
87.50
S.M.I.
7.S
Grading
Driveway Enc.
Infrastructure
$2,558.86
1.279.43
Lana Credit
1.279.43
TOTAL
IS2.324.731-
REMARKS
"t
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 INSPECTOR
12%27%68
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
RO GH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
EWER ORS IC
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
(FINAL)
TE". POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FRAMING
WATER PIPING
NOTE: Not to be used as property tax valuation
'F
W
FLOOR DRAIN
MECHANICAL FEES
REMARKS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SQ. FT. ® c
BATH TUB
ME H
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
F NISH GRADING
SQ.FT.GAR ® 3/ic
HOUSE SEWER
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 & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
RO GH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER ORS IC
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
REINF. STEEL
(FINAL)
TE". POLE
GROUT
WATER HEATER
RVICE '
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
OOFING
'F
W
�S Q
` /
REMARKS
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
IN ✓
ME H
foSULATIOWSOUND
F NISH GRADING
NAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL