04-3628 (RR)79691 Arnold Palmer
I IIIIIII VIII III VIII IIII 10
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BUILDING*.SAFETY DEPARTMENT
P.O..Box 1504 (7.60) 7774012
C1OF. ti9 78-495 CALLE TAMPIco FAX (760) 777-7011
LA .Q:UINTA, CA6YORRIA 92253 INSPECTION REQUESTS (760).777-7153-
BUILDING
760) 777-7153BUILDING PERMIT
App-lication .Number ;04-00003628 Date 4/21/04
Property Address 79691 ARNOLD PALMER
APN: 775-2417041- - -
-A•pplication description RE-ROOF
Property Zoning. .. .LOW DENSITY RESIDENTIAL
Application valuation '. .: . 7500
Owner Contractor
BEAUTYLAND' PROPERTIES, 'LTD EMERALD ROOFING INC
1027 HENRY ST . P.O. BOX 1963
KAfLUA.. 'KONA PALM -DESERT .. `,CA '92:2.61'
'SEBRING FL. 96740
WCC: STOVE INS.:
W
C; -04 0.1/01/05
CSLB: 77094.4 . 1.1/30/05
CCC: . ," ` C3.9 ' . • -
-Permit . RE-ROOF
Additional desc
Permit Fee . . . . . . 30.. 00 .- Plan Check Fee . 00
Issue Date Valuation 0
Qty Unit Charge .Per 'Extension
BASE 'FEE 30 . 00
Spec-ial . Notes and.. Comments
RE-ROOF .WITH POLYFOAM
Fee summary Charged . Paid . Credited Due
Permi.t .Fee Total 30 : 00 .00 . : : 00. 30. 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total . 30 . 00. ..00 . . 00 30 . 00
P.O. 5 1504 a s�G� �/
VOICE (760)777.7012
78-495 CALLE TAMrICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS'(760)777-7153
BUILDING & SAFETY DEPARTMENT
Application Number._0 aZ Date:
Applicant: Architect or Engineer.
Applicant's Mailing Address: Architect or Engineer's Address:
Lic.No.
BUILDING PERMIT DECLARATIONS .
LICENSED CONTRACTOR'S DECLARATION
1 Wmby atfim under penalty of perjay that I am rmoensW under p ons of Chapter 9(commencing w1h Section 700.0)of Division 3 of the Business and Professionsts
and my is 61 force and effect
Lioehse Class License No. '�7 a Y U
OWNER-BUILDER DECLARATION
t hereby��n Ynder penny of ply that I am exempt from the Cmi ractocs'Stab License Law for the fallowing reason(Sec.703.1.5.Business and Professions Code: Any
city or county that Mqi'res s permit b construct,alter Improve.dernolisth,or repair any structure,prior to Its issuance,also requires the applicant for the penTA to ilia a signed
statement that he or she Is licensed pursuant b the provisions of Ore Contractors'Stab License Law(Chapter 9(conxnencinp with Seton 7000)of Division 3 of the Business
and Protassiora Code)or Gnat he orshe is exempt theefiom and the basis for the spaged exemption. Any violation of Section 7031.5 by any 111 6"t r I for a permit subjects
the applicant to a dd penalty of not more than live hundred dollars(t5o0).r
U 1.as owns.of One propxty,or my employees with wages as their$ole cmWesa6on. 111 do One work,and the structure Is not intended or offered for sale(Sec.7044,
Business and Professions Code. The Contractors'Shah License Law does not apply b an owner of property who builds or impmHef thereon;and who does the work
himset or herself or through his or her own employees,provided that the improvements aro not intended or ofhxed for sale. tl however,the
sold within one year of completion.the owner-builder will have the burden of proving that he or she did not build or improve for the purpose of$ale.)
U Les owner of go prop".am exclusively contracting with licensed contracbrs 10 construct the project(Sec.7044,Business and Professions Code: The Contractors'
State License Law does not appy b an owner of property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed pursuant to
the Conbadors'State License Law.).
U I aim exempt under Sec._ .B.&P-C.for this,reason
Date' twee
WORKERS'COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
—I have and will maintain a certificate of consent to self-Insure for workers'compensation.as provided for by Section 3700 of the Labor Code.for the performance
Of the work for which this permit Is issued.
1 have and will mailrItt waders'compensation issuance,as required by Section 3700 of the Labor Code.for the performance of the work for which this permit is
y S(issued *03"oompersat'o^
N tuber rand policy number are:
amen—I certify•+at in the� this permit Is issued.I shall not employ any person in ani maraw so as b become sublert b the workers'
compensation taws of Calimila,and agree that.Y 1 should become subject b the workers'compensation provisions of section 3700 of the Labor Code.l shat
forftft.conply with those provisiorm
WARNING: FAILURE To SECURE WORKERS CATION COVERAGE IS UNLAWFt1L SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(=100.000).IN ADDITION TO THE COST OF COL4PENSATION,DAMAGES AS PROVIDED FOR IN'
SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. .
CONSTRUCTION LENOWG AGENCY
1 hereby affirm order penalty of perjury that them is a construction lending agency for the performance of the work for which Obis permit is issued(Sec.3097.Civ.C.).
Lende's Name
Lenders Address
IMPORTANT Application is flier APPLICANT ACKNOWLEDGEMENT
hereby made b the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person Won%+*m behalf this application is made,each person at whose request and for whose benefit work is performed under or pursuant to any permit
Issued as a result of this application,the owner,and theapplicant,each agrees b.and shat,defend.indemnify and hold harmless the City of Le Ou irita,its
officers.agents and employees for any act or omission related to the work being performed under or fonowing Issuance of this permit.
2- Any pend Issued as a result of this app6a860n becomes nut and void if work is not commenced within 160 d4Ys from date of Issuance of such permit,or
cessation of work for 160 days will subject permit to cancellation.
ISI have
read this appkaTion and state that the above information is correct 1 agree to comply with alt city and county ordinances and state laws relating to building
hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
ate "" :zr,`0 1-( hgnatum(App6cart
IIIIIII I III III VIII II 11 btro
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P.O. BOX 1504 No. 002710
Building 78-105 CALLE ESTADO
Address 79-698 AWld Palmar LA QUINTA,CALIFORNIA 92253
Owner
S'iw CO=MW BUILDING: TYPE CONST. OCC:GRP.
Mailing
Address 75-OOS QXMtry Club Drive A.P. Number
City Zip Tel.
palm - 92260 568- 82$ Legal Description
Contractor i�� uw.,.i,.� Y,.,.,� Project Description tPIA � {yam` PMM 13 B
fttiowi r.va.tilmm � i z3Xo rc.illi t �l
Address
'City Zip Tel.
State Lic. City DM2272
&Classif.289nQ Lic.# 320 Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
• -
Designer New C9 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 9(commencing.with Sect o
7000)of Division 3 of the_Business and Professions Code,and my license is`in''ffuulll,force nd'
effect .r i �• . ^./ /fry" � Al'
.SIGNATURE-
r OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation .344,517.48
reason: (Sec. 7031.5,Business and Professions Code: Any city or.county which requires a S. i
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 Plan Chk. Dep. '
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit p
subjects the applicant to aclvil penalty of not more than five hundred dollars(8500). ..Plan Chk. Bal. .77
❑1,as owner of the properly,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 Const. i
Professions Code: The Contractor's license Law does not apply to an owner of property who � .C
• 0
builds or improves thereon and who does such work himself or through his own employees, om CC•1ltY
provided that such Improvements are not intended or offered for sale. If, however, the building Mech. .t 00
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.)
❑ I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing 128.50
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. 9.84
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B.&P.C.for this reason
Driveway Enc.
Date owner Infrastructure 21000.00
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-insure; or a certificateof
Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.)
Policy No. Company
D Copy is filed with the city. ❑Certified copy is hereby furnished.
TOTAL 3.303.90
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued,I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line'
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued.(Sec.3097,Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR �-
This is a building permit when properly filled out,signed and validated,and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I.have read this application and state that the above information is correct. Issued by: -Date Z� "$�Perm'it
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. . f/",rI Validated by:
Signature of applicant Date��{+'�'
Mailing Address t Validation:
City, State, Zip
A6734 11 14 33 ,. 3,_ CF,
HARD COPY
CONSTRUCTION ESTIMATE NO. ELECTRICAL NO. PLUMBING FEES
1ST FL. SQ.FT.® a UNITS
YARD SPKLR SYSTEM
2ND FL. SQ.FT.
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I SQ.FT.
DRAINAGE PIPING
WALL SQ.FT.
DRINKING FOUNTAIN
SQ.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not 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,TEM/PERM LAVATORY
HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT.®c BATH TUB
SQ.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®11/4 c SEWAGE DISPOSAL
SQ.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 0�Joot GROUND PLUMBING/ UNDERGROUND A.C.UNIT COLL.AREA
&__*SLAB GRADE z OUGH PLUMB. BONDING HEATING(ROUGH) STORAGE TANK
KFORMS .a S (' ( SEWER OR SE T KUGH WIRING C� DUCT WORK ROCK STORAGE
FOUND.REINF.//,,6 GAS(ROUGH) METER LOOP I HEATING(FINAL) OTHER APPJEOUIP.
"k�EINF.STEEL ` ��O�s/f GAS(FINAL) TEMP.POLE
/ GROUT WATER HEATER SERVICE RA61NAL INSP.
BOND BEAM WATER SYSTEM 10
GRADING
LUMBER GR. ``` ��^ JNAL INSP. cu.yd.
FRAMING ; t f ^ FINAL INSP.f^r_4k / G ,p� $ plus x$ _$
ROOFING
bF��fOle 'r br b✓1 p 7, ��D`1/� RJbC, REMARKS:
VENTILATION aRy VV\(L n,A"L `s� �'• a 1 �```�
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
'4 GAR. FIREWALL
LATHING�•q^Q 1
MESH
Q�INSULATION/SOUND 3
FINISH GRADING 1
�uLFINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL