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003451 (SFD)r • CV P.O. BOX 1504 No, 003451. Building 78-105 CALLE ESTADO Address 55-910 Ppbb p Reach LA QUINTA, CALIFORNIA 92253 Owner _ Mailing BUILDING: TYPE CONST. OCC: GRP. ' Address 209 Plarr - A.P. Number 7269-360-016 City Zip Tel. . _ . Palm Desert 1.. 92260 Legal Description Contractor Project Description sziXy! la 'PA3►:L* 1y Diklellincr Stout Inc.6gicJ,. i o ti.S.i Address ia.,....h 140- • 73-754 HWY 111 �. r~�• . . City Zip .. Tel... - 'Palm Ower 92264 568-171 2 State Lic. City & Classif.382774 Lic. # ©Q ` Sq. Ft. No. No. Dw. ' Arch., Engr., - Size Stories Units 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 (commencing with Section +� 7000) of Division 3 of the Business and Professions Code; and my license is in full force and effect. _SIGNATURE DATE OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following ' reason:, (Sec. 7031 . 5,Business and Professions Code: Any city or county which requires a S permit to construct, alter, improve, demolish, or repair any structure, prior to.ils 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 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 '.permit Plan Chk. Dep.. 'subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - - ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan .Chk. Bal. m 11155.50 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 i C . A 1) 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.) - 11 0 +^ fS ❑ 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. In An such projects with a contractor(s) licensed pursuant to the Contractor's- icense Law.) Grading ❑ I am exempt under Sec. B. t> P.C..for this reason Driveway Enc. Date owner Infrastructure 96 nnn nn 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 O Copy is. filed with the city. ❑ Certified copy is hereby furnished. _ TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS -'s 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 tho 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 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 Line Rear Setback from Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line - 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.) 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 if work thereunder is suspended for 180 days. t I certify that I have read this application and state that the above information is correct. Issued by: Date Z�1�Pefmlt I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address _ Validation: City, State, Zip HARD COPY T CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. ® POR. SO. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. WALL SQ. 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 as property tax valuation COLL. AREA FLOOR DRAIN MECHANICAL FEES ROUGH PLUMB. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FORMS GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM DUCT WORK 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 TEMP. POLE SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/e c SEWAGE DISPOSAL WATER HEATER SQ.FT.GAR ® 3/ac HOUSE SEWER FINAL INSP. GAS PIPING PERMIT FEE WATER SYSTEM 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 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE 1 GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. f' FINAL INSP. FRAMING FINAL INSP. ROOFING o� Y� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL rt, 1 V K 0 01" MR 1 V ACJ/I MI I INLO, GARDEN WALL FINAL TED/05005 COACHELLA VALLEY UNIFIED SCHOOL DISTRICT CERTIFICATE OF COMPLIANCE (Government Code §53080) Project Name: Ro z ekq u;' t Project Address: 55-810 Pebbte Beach, La Quinta PGA WEST Project Owners Name: Tom Rosenqu,izt Phone No.: (6 19) 3G -8996 Project Description: Residence Building Type (circle one) Residential (Include No. Dwelling Units) Commercial Industrial Tract No. 20717-2 Lot No. 24 (If Tract attach Schedule "A" of all lots by tract, square footage for each lot and total.) Assessor's Parcel No. 769-360-016 (If Schedule "A" is used.show Assessor's Parcel No. for each lot if one exists or Assessor's•Parcel No. for parcels before sub -divided.) Total square feet of Building Area: Certification of Applicant/Owner. The person signing certifies that the above information is correct and makes this statement under penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer. Dated: Signature: City/County Certification: (signature r OPTIONAL: (title) (to be completed by school district) School district requirements for the above project have been or will be satisfied in accordance with one of the following (circle one): Gov. Code Gov. Code Agreement existing Not subject_to 53080 65970 prior to 1/1/87 fee requirements A AB 2926) (SB 201) Total number of sq. ft. n AS PER AGREEMENT - $628.00 Amount per sq. ft. $ PER UNIT;: Amount collected $ 628.00 A�zic Cant Supeucintendent, School District Officia " Title Educationae SeAv i ce/s Phone No. 6q 9 = 39 5 T 37 Date Annit 13. 1988 Note: AB 2926 and SB*201 fees are capped at $1.50 per square foot for residential construction. AB 2926 is capped at $0.25 per square foot for commercial and industrial projects.