6805T4ht 4 4 Q"
P.O. BOX 1504
Building r 78-105 CALLE ESTADO
Address '4-- 35,y Shoal Creek LA QUINTA, CALIFORNIA 92253
Sunrise Comany
Mailing
Address 42-6€ 0 Cook St. , SO'16P 200
City Zip Tel.
Palm Deser4 92260
566-2828
Contractor
National Land & tior'tQm
Address
ty
State Lic. City
& Classif. 28B130 Lic. #
Arch., Engr.,
Designer
Address Tel_
City I
Zip I 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 in full force and
effect.
SIGNATURE 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
permit to construct, alter, improve, demolish, or repair any structure, prior to 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 taw, 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, 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.)
❑ 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
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 certified copy thereof. (Sec. 3600, labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it 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
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: N, 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.
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, Civr1 Cede.)
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
No. 06805
JILDING: TYPE CONST. OCC. GRP._
P. Number PGA WEST r Phase 23,,,
Legal Description
Project Description Tract 20717m 3 • Plan
Sq. Ft. No. No. Dw_
Size Stories Units
New 11 Add U
Alter C 1 Repair I I
Demoliti<
Estimated Valuation
$113,727
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
• 5
Mech.
I
Electrical
U
Plumbing
1 1 • 15-
S.M.I.
7.9
Grading
Driveway Enc.
Infrastructure
Vs b;b. ac
1,279.4
Credit
9 3
r
TOTAL
u
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
Issued by:
Validated by:
Validation:
INSPECTOR
Date Permit
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
SQ. FT ®
$
UNITS
L.
SD. Ff.
YARD SPKLR SYSTEM
SO FT a
MOBILEHOME SVC.
BAR SINK
SO FT @
POWER OUTLET
ROOF DRAINS
SQ. FT.
DRAINAGE PIPING
SO. FT. ®
DRINKING FOUNTAIN
SQ FT ®
1ATED CONSTRUCTION VALUATION
URINAL
$
WATER PIPING
Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
'STEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
ICE DRYER
GARBAGE DISPOSAL
:E UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
DLING UNIT CFM
KITCHEN SINK
TION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
SSOR HP
POLE, TEM/PERM
LAVATORY
!SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
B.T.U.
SQ. FT. @ c
BATH TUB
SQ. FT. ® c
WATER HEATER
ATER OUTPUT, B.T.U.
SO. FT. RESID (a 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR Q 3/nc
HOUSE SEWER
GAS PIPING
EE
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEE
CONST. FEE I
ELECT. FEE
SMI FEE
PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
3 GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
MS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
ND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
IF. STEEL
GAS (FINAL)
TEMP. POLE
,UT
WATER HEATER
SERVICE
FINAL INSP.
D BEAM
WATER SYSTEM
GRADING
cu.yd.
$ plus x$
_$
BER GR.
INAL INSP.-
MING
FINAL INSP.
FING
REMARKS:
TILATION
ZONE ROOFING
PLACE
3K ARRESTOR
FIREWALL
IING
H
ILATION/SOUND
iH GRADING
L INSPECTION
'. OCC.
:E FINAL
INSPECTOR'S SIGNATURES/INITIALS
BEN WALL FINAL