9909 (ELEC)P.O. BOX 1504 V No. 990,9
Building 77750 AVENI.DA 50 78.105CALLEESTADO. L. \j�y
Address LA QUINTA, CALIFORNIA 92253 r
Owner
LA OUINTA COUNTRY CLUB _771R'[JlLDlNr,-- TYPF CnNBT. Orr' f.RP..
' Mailing
Address P 0 BOX 99
City
Tel.
LA QU.INTA,CA't°-
JZip
.: 9.2253..
564-4151
Contractor
MEREDITH & SIMPSON COSY RRUCTION
Address
P 0 DRAVORlY
City
Zip
Tel.:
iYdBIO
92201
347-23bb
State Lic.
& Classif. .201308ABC-8 9,C10, C37
C'ay r
ic. #<'
Arch,, Engr.`,''"�
• • Designer
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,Code, and my license is i dull force and
�. effect-
• •{ SGNATO DATE
OWNER -BUILDER DECLARATION .
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
,grmit to construct, alter, improve; demolish, or repair any structure, pdorto its issuance also
requires the applicant' for such permit to file a signed statement that he. is licensed pursuant to
the provisions of the Contractor's License Caw, 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.(S500): '
❑ ;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 forsale..(Sec..7044, Bussness 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. li however„ the building of 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 safe.)
b 1, as owner of the property,•am exclusively contracting with licensed contractors to*con-
slruct the project. (Sec. 7044, Business -and Professions Code: The Contractor's License _Law -
does not apply to an owner of property who builds or improres.thereon, and who contracts. for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑Jam exempt under Sec. B. & P.C. for this reason
Date Owner �+
1
WORKERS' COMPENSATION DECLARATION.
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a ce��jifi copy t� g$t�. (Sep @pp.labor�q�g
Policyt,No: Company' �LIIiSSl;4e .1A3!'.T$!"111 Y
0 py is4iled with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM'
WORKERS'COMPENSATIONINSURANCE
(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 the 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
'subjectto. 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
I hereby affirm that there is a construction lending agency foathe 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 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.
Signature of applicant Date
Mailing Address
City, State, Zip
A.P. Number
Legal Description
Project Description 600 AMP SEkVICE-
t
Sq. Ft.
Size - -
No.
Stories
New ❑ Add O
Alter ❑
Estimated Valuation
$'600o
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const'.
Mech. -
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure.
`
No. Dw.. .
" Onits
Repair ❑ Demolition ❑
it AMOUNT
h
Y3.7a50
1-5.00
TOTAL
REMARKS'
tt .F`s- 3 fInAt ':. nz,`v
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 _ Pe[mit- .
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL ;
NO.
PLUMBING FEES
1ST FL. SO. FT. ®
2ND FL: SO. FT.
POR.. SO. FT. ®
GAR. S0, FT, ®
.,,CAR°P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED. CONSTRUCTION VALUATION
$
UNITS
-
'YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK '
POWER OUTLET
IftOOFDRAINS, .
DRAINAGE PIPING
DRINKING FOUNTAIN: -
URINAL
$
WATER•PIPING
` NOTE:.NoI to'be used as property tax valuation' - -
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE :UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY.
:• `
AIR HANDLING UNIT CFM
KITCHEN. SINK
ABSORPTION -SYSTEM. B-T:U.
TEMP USE PERMIT SVC
WATER CLOSET`
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT.'
SHOWER,
BOILER. B.T.U.
SO. FT. ® b
BATH TUB..
r
SO. FT. ® c.
WATER :HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vs c
SEWAGE, DISPOSAL
.•
SO.FT.GAR ®3/ac
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' ..
"CO LL• AREA• .
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK t
FORMS,
SEWER OR SEPTIC TANK
ROUGH WIRING.
:'.DUCTWORK,
ROGKSTORAGE '+
F,OUND..REINF
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
+
OTHERI'APPJEOUIP. .'
REINF. STEEL
GAS (FINAL)
TEMP. POLE
e 'GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING_
cu. yd.
$ plus
-
x$ _$
GR -LUMBER .
. ..
FINAL INSP. p � �
FRAMING
FINAL'INSP-
ROOFING
REMARKS:
VENTILATION
FIRE, ZONE ROOFING
• "-:; .;. , .
FIREPLACE'
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH:
INSULATION/SOUND
FINISK-GRADING
FINAL` INSPECTION-
CERT. OCC.
FENCE:FINAL-
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
",