04355 (SATT)wit�t 4 sCP Q91am
P.O. BOX 1504
78-105 CALLE ESTADO
Addrress 55-f59 r�dlsl.nlvwo"' LA QUINTA, CALIFORNIA 92253
Owner
Sunrise Comnam,
Mailing
Address f s-0J5 CO-Lmtry Cluh Drive
City Zip Tel.
Contractor
Natit-ri7� `Fib *lltAmp
Address
ty I Zip I Tel.
ate Lic.
&tCla sif. 28813
Arch-, Engr-,
Designer
Address I Tel.
City I Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of ❑Ivislon 3 of the Business and Professions Code, and my license is in full lorro and
.�effecl.
SIG
N T OE nFATF
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: ISec. 7031.5,Business and Professions Code: Any city or county which requires a
p9rmd to construct, alter, improve, rfamWish, or repair any structure, prior to as Issuance also
requires the applicant for such permit to Me a signed statement that he is licensed pursuant to
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 a permit
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
do the work, and the structure Is not intended or offered for sale- (Sec- 7044, gwsness 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.)
❑ 1, as owner of the proparhy, am exclusively contracting with licensed contractors rc con-
struct the project. (Sec. 7044, Susness and Professions Coda: 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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 certifi-d copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
RCopy is filed with the city. ❑ 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 whlch 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 Ibis 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 Penn# shall be deemed revoked.
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. ISec. 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 if work thereunder is suspended for 180 days.
i certify that I have read this application and stale 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 Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number PC IA T-47%gt — .-;rite GxLens
Legal Description
Project Description Plan Ad!R -- Pbetse 7L
Sq. Ft. 3 *• 2 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
Ir r X
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
} '� •
Const.
• 00
Mech.
' + 90
Electrical
•14
Plumbing
S.M.I-
■
Grading
Driveway Enc.
Infrastructure
TOTAL
• - h • .
REMARKS
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 MRECT9R
.
Issued by- Date Permit
Validated by:
Validation:
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING; GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO
ELECTRICAL FEES
NO
PLUMBING FEES
1ST FL SO FT rp
2ND FL SO FT ky
POR SO FT Cr
GAR SO FT tr
CARP SO FT a
WALL SO FT m
SO FTra
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE Not to be used as property lax valuation
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.0
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B T.0
SO. FT. ® c
BATH TUB
SO FT. ®c
I WATER HEATER
MAX. HEATER OUTPUT, B T U
SO. FT. RESID ( 11/4 c
SEWAGE DISPOSAL
SO FT.GAR rg 3/.c
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
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 APPJEOUIP
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
FINAL INSP
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
IDI 1 IION
C/ERT OCC
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL