003247 (SFD)P.O. BOX 1504 No. 00324
Building 78-105 CALLE ESTADO
Address r A— Q'p nvr=v-ViA LA QUINTA, CALIFORNIA 92253
Owner I
. _
Sunrise Company
Mailing
Address —OAS C mi trw t`xrf€b I31L"ive
City Zip - Tel.
Contractor
$ aae•'. ;a'w'.M}a'At'.a M_/1 s X,1°E�X71R� -.
.Address
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number PGA West '
Legal Description
Project,Description . Phase :22B, Plan 30 -MR
City
Zip
State Lic.
City
& Classif. 288130
Lic. # 328
Sq. Ft. -D 2825
No. _ No. Dw.
Size �-
Stories Units
Arch., Engr:, . _
_
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
_
Lic: #
• 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 fulf•force and
effect.. < ,i,
_ - ..j I . • i I _. X 41. �•��-> 7 r i '77
SIGNATURE DATE
" OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractors License Law for the following's
. reason: (Sec. 7031.5,Business and Professions Code: Any city or county' which requires .a
permit to construct, atter, improve, demolish, of repair any structure, prior to its .issuance also
requires the applicant for such permit to file a signed statement that.he is licensed.pursuantdo
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of-
' Division 3 of the Business'and Professions "Code, of that. he is exempt therefrom, and the "basis
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 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
Estimated Valuation
�92..00
- PERMIT
- AMOUNT
Plan.Chk. Dep.
Plan Chk. Bal.
� 555.1.0
Const.
G r�
670. 50
Mech.
.
- - -55.Oin
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. .1f, 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.) -
Electrical
-
_ 901-71
Plumbing
' ❑ 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.) •
..O I am exempt under Sec. B. 8 P.C. for this reason
S.M.1.
-
- '1
Grading
.
Driveway Enc.
Date owner
Infrastructure
2 0 Ont). 06
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. ❑ 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 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
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, Civ,&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"andcounty 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 COPYI
TOTAL q`.srir,9• _ AI
REMARKS
- `h�S.�tf'3'7 jr'i•:c�7t1 t1'a'�.:'}i—s'p'a'. .. •i:�
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
Issued by: Date ?%20/1 Permit
Validated by:
Validation: