001785 (SFD)Building 9"99
Address nmrnm
Mailing
Address 75-005 OMMI
City Zip
Palm Diesertl
Contractor
Q" -
P.O. BOX 1504 No. 001785
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 r
BUILDING: TYPE CONST. OCC. GRP.
y Club D'i'm A.P. Number
Tel.
922660 563-2828 Legal Description
Project Description PGA tM P 30 C
Sam
City Zip
$ Sam
State Lic.
& Classif.
• Arch., Engr.;
Designer Pabem-r. Al3S Ai
Sq. Ft. MZ 2US
Size - MR 56$
New n Add C
No. No. Dw.
Stories Units
Alter ❑ Repair ❑ I Demolition ❑
Address
Tel.
2915, Iced RM
(71.4). 540-5117-
540-5117_City
., .
City
Zip
State
ODStA Mew
-92626
Lic. #
LICENSED CONTRACTOR'S DECLARATION �
e
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with clio`n
7000) of 3 Business Professions
Division of the and Code, and my license is iw II,force°and ✓
SIGNATURE DATE'
f OWNER -.BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
Estimated Valuation p s/�+� /}
178030 .0V '
reason: (Sec. 7031.5,Business and,Professions Code: Any city or county which requires - a -
permit to construct,' alter, improve, demolish, or repair any structure, prior to its.issuance also
requires the applicant for such permit to rile 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 Buslness and Professions Code, or that. he is exempt therefrom, and the•basis-
for the Any Section 7031.5 'any for
..
PIanChk. Dep.
alleged exemption. violation of "by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500)i
I,
`� `� �.
Plan Chk. Bal. ?
❑ 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
-
COr1S
t. '630.50
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,
that
Mech. - r�
5S•00
provided such improvements are.not intended, or offered for sale. If, however, the building
or improvement Is sold within one year of completion, the owner -builder will have•the burden
` Electrical ��yy
321.
of proving that he did not build or improve for the purpose of sale:) . -... ,
-+f1
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing ioai7s 7iA'
• 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 10 the Contractor's License Law.) -
•3�3
Grading
O 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
0 Copy is filed with the city. O 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 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 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
Ihereby 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. /J
Signature of applicant 7 Date/Z �-
Mailing Address ► ! !�
City, State, Zip
HARD COPY
TOTAL 3.435.17
REMARKS
POM14 13SM PAW OF TM P.£T.
NW
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--- Permit
Validated by:
Validation:
A3180 11 13 5485,17 CY,
CONSTRUCTION ESTIMATE r t
NO. ELECTRICAL FE
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL.SO. FT.
POR. SQ. FT. p
GAR. SQ, FT, ®
CAR P. SQ. FT.
WALL SO. 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 aspropertytax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH) L
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK 3
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL) ,•
HEATING (FINAL—Jr-ft
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
I-
TOTAL FEES
MICRO FEE MECH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FE7 PLUMB. FEE
-STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUMBING/Z S
UNDERGROUND
A.C. UNIT
COLL. AREA
FLAB GRADE JCR /
ROUGH PLUMB.3 74
BONDING
HEATING (ROUGH) L
STORAGE TANK
FORMS &I p .
� J
SEWER OR SEP
ROUGH WIRING 3
DUCT WORK 3
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP �l�
FINAL) ,•
HEATING (FINAL—Jr-ft
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) & ?
v�
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ —Plus—X$—=$
LUMBER GR.
FINAL INSP.
FRAMING 313
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL_
LATHING err
MESH
INSULATION/SOUNDS [/ f4—rj
c
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL .
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL