04121 (ELEC)Building
Address
Owner
41e k
t P.O. BOX1504'
78-105 CALLE ESTADO
56-1.1.0 Pabbbe Beach. LA QUINTA, CALIFORNIA 92253
Address is-OUS CoUntr
City _ Zip
PBI.* Desert 1 92260
Contractor
Watriontal Mort
Address
City Zip
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
28813D
.canners BUILDING: -TYPE CONST,- w OCC. GRP.
Club Drive : a A.P. Number » . -:�(x4 �i" st "° THE G�!�i�f��" • }
Tel. _
5 ,0,_:2$28 Legal Description
Project Description Comwn area veter Pedestal
-10O.-iry service
Tel.
City
Lic. # 328,.. ,.
Sq. Ft.. • - No: - No. Dw.. ' � -
Size Stories Units
New ❑ Add Alter ❑ Repair ❑ Demolition ❑
Tel.
S. >
- City
Zip
State
• _
Lic. #
-
LICENSED CONTRACTOR'S DECLARATION p
I � hereby affirm that I am licensed under provisions of Chapter 9 (corlenc ing.with Section
7000) of Division 3 of the Business and. Professions Code, and my;liceyyfi{ a isIff`uil force and
effeL,�l �-Y / tCJ�f# f /E
, _ -
SIGNATURE"— 1 A 9 V DATE
OWNER•BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason::(Sec,-; 7031.5,Business and Professions Code: Any city or county which requires a
permlt: tp; cpnstruct, atter, Improve, demolish, or repair any structure, prior to its issuance also
regolres,!I ,;applicant for such permit to file a signed statement that he is licensed pursuant to
thethe Contractor's License Law, Chapter 9 (commencing with Section 7000) of
.,`DiQisfon.:3-�o(ifheBusiness and Professions. Code, or that. he is exempt therefrom, and the basis
-'for!th6,{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 live hundred dollars ($500).
❑ I; as ownerof 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
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. If, 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.)
Estimated Valuation r
- -
PERMIT - AMOUNT
_
Plan Chk. Dep.
-
Plan Chk. Bal. -
Const. -
Mech.
` �b +�.'� �+�py
Electrical .$22 22 s J V
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.)
❑ I am exempt under Sec. B. & P.C. for this reason
,
S•M•j•
Grading
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. 3900, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
,y�'♦1 �,r pf ��e ly�y� �t
J+•Gf•1! tt'i,.6l>£7�' 1440 PV b4"'U4t 8ti 22a.t„j0Iw
(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
r 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.
_.
ZONE: - BY:
Minimum SetbackDistances: '
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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
Side Street Setback from Center Line
- -
Side Setback from Property Line
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 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.'
FINAL DATE INSPECTOR—
, - ,� / �� 8
Issued by: Date Permit '
e
A
Validated by: " - "
Signature of applicant Date
Mailing Address
, Validation:
y _
City, 'State, Zip
WHITE FINANCE PINK APPLICANT GREENBUILDING,
�,nt?,.t`/ s , t i..1± .5:4_' cs '' .a r +i"7 j� ;s. �.... ..• c't . c._ ."�;r,..- . - .. .rf_ - .. - • •i4(�-
GOLDENROD ASSESSORS OFFICE HARD COPY - FILE - •• x
l.�l1 �,. - tT�`r.s.,,,'LI. - ,)r. ..r .•,f '; :
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (p S
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
Y
SPKLR SYSTEM
2ND FL SO FT. (IrARD
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTa
GAS (ROUGH)
METER LOOP
GARSO. FT. Cl
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO FT. a
GROUT
WATER HEATER
WALL SO. FT. a
FINAL INSP.
DRINKING FOUNTAIN
SO FT @
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
-
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.
SO. FT. ® c
BATH TUB
LATHING
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 114 c
SEWAGE DISPOSAL
SO.FT.GAR rg 3i:c
HOUSE SEWER
FINISH GRADING
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 8 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.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
j pIUS xS
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
'SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL