003280 (ELEC)Building
Address C;r%-701t?^Tllnr�rl
Owner
Sunrise Company
Mailing
Address 75-005 Country
City Zip
... Palm Desert 920610
Contractor
P.O BOX 1504 No, 003280
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP. -
Club Drive A.P. Number PGA West
Tel.
. . 564"-6716 6 Legal Description
Project Description 300 ANT "Pool Pedestal
City, State, Zip
HARD COPY
City .
Zip
Tela .. _
State Lic.
City
& Classif. 2-8133
Lic. # 328Sq.
Ft.
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 Codejand my license is in full force and
�effect. .�">'. . a ��1�'✓1i�li'r�..z s :. !;
SGNATUREi."_". _ rx "'. DATE.
-. ..
- OWNER -BUILDER DECLARATION
EStlmated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
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reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county - which requires a.
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peimit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also, 4
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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
sr
Division 3 bf the Business and Professions Code, or that.he is exempt therefrom; and the basis
for the alleged exemption. Any violation Section 7031.5 by 'any for
Plan.Chk. Dep.
of applicant a permit
" subjects the applicant to a civilpenaltyof not more than five hundred dollars (5500).
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Plan Chk.. Bal..
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❑ 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
Const.'
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,
or improvement is sold within one year of 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-.
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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
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.
TOTAL
22,.50
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CERTIFICATE OF EXEMPTION FROM
REMARKS'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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or less.) .. .. .
I certify that in the performance of thg work for which this permit is issued, I shall not
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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:
ZONE:
BY: -
sub)ect to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
SetbacKDistances: '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line '
-1 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.)
Side. Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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 Lhave this
read application and state that the above information .is correct.
I
Issued by:
Date-.8-5—S7Permit
`
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
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