04094 (SFD)Building 5'�'"" 612 • 1ave'�,3 ass
Address
Owner
sunrise comaA AT
Mailing
Address 75-•005 ticu 9try
cAalm Desert Zip 92160
Contractor
Address
City
0094..
P.O. BOX 1504
78-105 CALLE ESTADO
LA,QUINTA,,,CALIFORNIA 92253
BUILDING: TYPE CONST. OCC. GRP.
14: h nr,' ve A.P. Number P(IA Wast,
Tel. . _. .
�p6e"2928.. Legal Description
h*Se 2513 t Plzen 30M
Project Description
r .�
State Lic. I City
& Classif. 288130 Lic. #
Arch., Engr.,
Designer
Address Tel.
City ( Zip ( State
et. Lic. #
LICENSEDCONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
,7000) APDivision 3 of the Business and Professions Code, and my license is in full force and
effect....t ,. .
_SIGNATURE f 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 that. he is exempt therefrom, and the bask
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).
0 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
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
or improvement 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
Ihereby 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 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, 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 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.
Signature of applicant Date
Mailing Address
City, State, Zip*
REMARKS
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 �1E�J60R
Issued by: Date -Permit
Permit
Validated by:
Validation:
WHITE FINANCE PINK APPLICANT, GREEN - BUILDING, GOLDENROD ASSESSORS OFFICE, HARD COPY - FILE
Sq. Ft. 2826No.
Size
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$194492
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
• x
Const.
bM• 3U
Mech.
Z�+'t V
Electrical
Axis, 7
Plumbing
Oto . t
S.M.I.
+ •0i
Grading
Driveway Enc.
Infrastructure
♦ n
TOTAL
y t
REMARKS
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 �1E�J60R
Issued by: Date -Permit
Permit
Validated by:
Validation:
WHITE FINANCE PINK APPLICANT, GREEN - BUILDING, GOLDENROD ASSESSORS OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
iST FL SO FT (p Z
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SO FT. M
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC
METER LOOP
BAR SINK
POR SO FT a
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GAR SO. FT. 0
POWER OUTLET
GROUT
ROOF DRAINS
SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SO FT. 40
GRADING
cu. yd.
j plus x5
=S
WALL SO FT. 0
FINAL INSP
DRINKING FOUNTAIN
SO FT. (a
ROOFING
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE, Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOI(DISH)
APPLIANCE DRYER
SPARK ARRESTOR
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
I ITEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE.TEMIPERM
FINISH GRADING
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
(�
SHOWER
BOILER B.T.U.
SO. FT. ® c
CERT. OCC.
BATH TUB
SO. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID fd 114 c
SEWAGE DISPOSAL
GARDEN WALL FINAL
SO.FT.GAR Sac
��
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
7
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 (ROUGHI
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.
j plus x5
=S
LUMBER GR.
FINAL INSP
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
IN ION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL