003388 (BLCK)Address
54-838 Inyernes
Owner
& Classif. 288130
Sunrise Company
Mailing.
No. No. Dw.
Address
75_046 Country .
CityZip
Stories Units
'Arch., Engr.,
. Palm.
Desert
i. - X32260
Contractor
' Alter O. Repair ❑ Demolition 0
4
P.O. BOX 1504 No. 003388
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Club' Ori ve • - -
Tel.
564-671fi
Natinal 'Land A Mortgage
Address _
- jZip ITO.-
BUILDING: TYPE CONST. OCC. GRP.
A.P..Number PGA West
Legal Description
Project Description FrhiiSe 26A
4961 of 61" High Block Wall
State Lic.
City
& Classif. 288130
Lic. #
Sq. Ft.
No. No. Dw.
..328
Size -
Stories Units
'Arch., Engr.,
Designer
New O - Add ❑
' Alter O. Repair ❑ Demolition 0
Address
Tel
City
Zip
State
Lic: #
- LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that l am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and license is.in full force and
Ymy
..effect. �! f� - �'�. •. 1;Arr'"I,.1.1 v+. t� !�r .•
.
_k s�.
_SIGNATURE DATE
"
' OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
4!!f1 '
60
reason: (Sec. 7031.5,Business and Professions Code: Any city, or county which requires a
"
1 g
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
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
' Division 3 or the Business and Professions Code, or that. he is exempt therefrom,, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any -applicant for a permit
-
Plan Ch k: Dep. •
'
It6 A tai
'subjects the applicant to a civil penalty of not more than five hundred dollars -($500).
Plan Chk. Bal.,
- -
O _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. (Seca 7044, Buisness and
Professions Code: The Contractor's License
Const.
Q A
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.
_ 11
-
provided, that such improvements are not intended or offered for sale. If, 'however, the building
or improvement is sold within one year or completion, the owner -builder will have•the burden
Electrical
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-
Plumbing
• 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
S.M.I.
• - such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
_ - - -
Grading
❑ I am exempt under.Sec. B. & P.C. for this. reason
Driveway Enc.
s 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, or a certified copy thereof. (Sec. 3800, Labor Code.)
' Policy No. Company
❑ Copy is filed with the city.. 0 Certified copy is hereby furnished.
TOTAL
6 (t
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE t
(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 or Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions'of 'the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: '
Front Setback from Center Line
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 it 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
Rear Setback -from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date-Q.121.IdR?Permit
Validated by:
Validation: