003832 (SFD)P.O. BOX 1504 No. 00383c
Building 78-105 CALLE ESTADO
Address 54-7.18 Inve.rnes..00 LA QUINTA, CALIFORNIA 92253
Owner
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address 75.005 005) 4'+ountry Club Drive ------ A.P. Number PGA West
City Zip Tel. +M
�'ai: m D>� 92260 Legal Description
Contractor Project Description Phase 288. Plan 301
Natiofial kortuacre A land
w: Address .
City Zip Tel. -
State Lic. City
& Classif., 288130 Lic. # • _,326 „ „ , Sq. Ft. :DWG. 2825 No. No. Dw.
Size _A1:k rad.AStories • Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
1 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 . • ;,,. -) . - / ! • .
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following �y� - -
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 PERMIT - - AMOUNT
the provisions o/ the Contractor's License law, Chapter 9 (commencing with Section 7000) o/
Division 3 o/ the Business and Professions Code, or. that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation o/ Section 7031.5. by 'any applicant lora permit Plan Chk. Dep. ,
subjects the applicant to a civil penalty of not more than live hundred dollars ($500). r
p I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk.. Bal. w(�
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bufsness and s
Professions Code: The Contractor's License Law does not apply to.an owner o/ property who Const. 670.541
builds orimproves thereon and who does such work himself or through his own employees, Mech. - CC �pa
provided that such improvements are not intended or offered for sale. If,, . however, the building J n►. 0
or improvement is sold within one year of completion, the owner-builder will have the burden Electrical '
o/ proving that he did not build or improve /or the purpose of sale.) _ 1.2 4 . 7 ,
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing + r
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law s
does not apply to an owner of property who builds or improves thereon; and who contracts for S•M•I, - '• .l +f
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) •�•
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure 390.57
WORKERS' COMPENSATION DECLARATION
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.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed i/ 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: I/, after making this Certificate o/ Exemption you should become ZONE: BY: '
subject to the 'Workers' Compensation provisions o/ 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 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. s
I certify that I have read this application and state that the above information is correct. Issued by: Date/ I7RA 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
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL �-
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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
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./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE -
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
FINAL INSPECTION
CERT. OCC.
FENCE FINAL -
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL