003236 (SFD)4 44 0
CV it Qu
. . '
P.O. BOX 1504 No.
�
Building 78-105 CALLE ESTADO
36
Address 54-820 Xnii9RtrnetS LA QUINTA, CALIFORNIA 92253
Owner
BUILDING:.TYPE CONST. OCC. GRP..
Mailing
Address 75.005 Country Club Drive,. A.P. Number PGA WaBL
ip
City ZTel.
Pam Desert 92260 —5(;
$-2$28 Legal Description
ContractorAM
Project Description Phage i6At ' Pi3Ii
National Mrtaaae Land -
Address.
City. _ _ .. Zip . Tel..
State Lic. City
& Classif. .288130 Lic. # 328 . _ Sq. Ft. - MG l9= 6 No. _ No. Dw.
..._Arch:; Engr:, _ _ .... _
Size R 424 Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of.consent to self:insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company ?
❑ Copy is .filed with the city. ❑ Certified copy is hereby furnished.°
_ TOTAL za;,rrarl x yr I tr%_ 1 9�iY7
CERTIFICATE OF EXEMPTION FROM REMARKS
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 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 you should become ZONE: BY:
subject to the Workers' Compensation provisions of the -Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. '
Front Setback from Cn t L'
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
HARD COPY
eer Ine ,
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date -1 /')A/ A Permit
Validated by:
Validation:_
Address
Tel.
//
City. r
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
.1 hereby affirm that,l am licensed under provisions of Chapter 9 (commencing with Section
.n
7000) of Division 3 of the Business and Professions Code, and mylicense'is in full force and
-
effect.
_ _SIGNATUREI DATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: 703%5,:siness Professions Code: Any
w.w9 9 �e C�+ nA
�A132, 916.00
(Sec. and city or county which requires a
• permit. to construct, rafter, improve, demolish, or repair any structure, prior to its issuance also
- -
requires the applicant for. such permit to rile a signed statement that lie is .licensed pursuant to
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter. 9r(commencing with Section 7000) of.
-
Division 3'of the' Business and'Professions Code, or that.he. is exempt therefrom, and the basis
for the Any Section 7031.5' by any
Plan Chk. Dep.
-
alleged exemption. violation of applicant for a'permit
'' subjects the applicant to a civil penalty of not more than five hundred dollars'(8500). -
-as
Plan Chk. Bat.
-
'4
❑ I, 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
COf1St.'
,AAA
♦
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,
Mech.
-- '
provided, that' such improvements are not, intended or offered for sale. If, however, the, building
-4A An
or improvement is sold within one year of completion, the owner -builder will havethe burden
Electrical
-
-i
of proving that he did not build or improve for the purpose of sale.),
in a ..
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
- strucl 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
S.M.I. -
6•-
such projects with a contractors) licensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 am exempt under Sec. B. & P.C. for this.reason
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of.consent to self:insure, or a certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company ?
❑ Copy is .filed with the city. ❑ Certified copy is hereby furnished.°
_ TOTAL za;,rrarl x yr I tr%_ 1 9�iY7
CERTIFICATE OF EXEMPTION FROM REMARKS
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 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 you should become ZONE: BY:
subject to the Workers' Compensation provisions of the -Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. '
Front Setback from Cn t L'
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
HARD COPY
eer Ine ,
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date -1 /')A/ A Permit
Validated by:
Validation:_
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SO. FT. @
GAR. SO. FT. @
CARP. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
METER LOOP
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEQUIP.
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.
SQ. FT. @ c
BATH TUB
WATER SYSTEM
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
FINAL INSP.�7�5,
SQ.FT.GAR @ 3/ac
HOUSE SEWER
ROOFING 1� (�j/
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE JPL.CK.FEE
CONST. FEE ELECT. FEE'
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND LMB
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
J
SEWER OR SEPTIC TAN ROUGH WIRING
DUCT WORK
ROCK STORAGE
p
FOUND. REINF. �/ 1
v
�AS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd..
plus
LUMBER GR.
FINAL INSP.�7�5,
FRAMING ��% /1 7
Y/
AL INSP.
v,
ROOFING 1� (�j/
GAIL► /O 2Z p
/..+ %�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING p/w It
MESH
INSULATION/SOUND lJ
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL