001789 (SFD)4
P.O. BOX 1504 No. 001789
Building 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing'
BUILDING: TYPE CONST. OCC. GRP.
Address � � Club Drive A.P. Number
CityZip Tel.
Palm 922f:t3.6&282$ Legal Description
Contractor Project Description PGA =MS`{4 Pte? 30M
�* Z � amd $�ip J
.Address .
City... ...- Zip .. Tela -
Sam
Sam
SMW
State Lic. City 2272
& Classif. Lic. # 328 Sq. Ft. (;M582 No. 2 No. Dw. 1
Arch.; Engr., Size- Stories Units
Designer New CK Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
29151 Red HAI Avg. (714 f 540-6n7
CityZip State
ta. 92626 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,i/s- in'full.foorrce,arfcl_ . +
_SIGNATURE / ,rr' DATE
OWNER•BUILDER DECLARATION Y
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031. S,Business , and. Professions Code., Any, city or county, which, requires 'a � • � *� f
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 of the Business and Professidns Code, or thathe is 'exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit ,Plan Chk: Dep.
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 Plan Chk. Bal. ` _462.89
i
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and r1S
�CO
Professions Code: The Contractor's License Law does not apply to an owner of property who t. - 545.50
builds or improves thereon and who does such work himself or through his own employees, Mech. �V
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- �Q'��
of proving that he did. not build or Improve for the purpose of sale.) - .
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 128. 50
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. 9.84
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.
Date owner Infrastructure 2,000.00
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
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'. COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation WMJkM WA aaiz7a. RAW (W 111= W 'MT
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. M Eli= M115
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 Center I in
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 subjecrlo
expiration if work thereunder is suspended for 180 days.
I certify that.l 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 •'`/ -� St/,� t % .�/ Dater �`1
Mailing Address ; f V✓ i ✓
City, State, Zip
e
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by:, Date.Permit
r.. Validated by:
Validation:
A,3192 11 13 33,,3 9 (; CK
HARD COPY a
CONSTRUCTION ESTIMATE V ':'.
NO. ELECTRICAL Ekaijkt
NO. PLUMBING FEES
IST FL. $Q. FT. ® $
UNITS
A.C. UNIT
2ND FL. SC.. FT.
B GRADE /
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
SEWER OR SE
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK • 3
DRINKING FOUNTAIN
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
/
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN `.
WASHER(AUTO)(DISH)
APPLIANCE - DRYER
WATER HEATER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK .
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U. -
SQ. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
VENTILATION
SQ.FT.GAR ® 3/ac
HOUSE SEWER
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 .21,
UNDERGROUND UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE /
ROUGH PLUMB
BONDING
HEATING (ROUGH
STORAGE TANK
FORMS ��
SEWER OR SE
ROUGH WIRING
s
/
DUCT WORK • 3
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
/
HEATING (FINAL .4;,
OTHER APPJEQUIP.
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 �
J CCC���
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR •
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND3 �(p
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
<
GARDEN WALL FINAL