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0312-201 (RER)
79713 Arnold Palmer LICENSED CONTRACTOR DECLARATION PERMIT# U) I hereby affirm under penalty of perjury that 1 am licensed under provisions of BUILDING PERMIT 0312-2.01 Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE I VALUATION LOT TRACT cel W Professionals Code,and my License is in full force and effect. ! . 9 •f O =) ch License# Lic.Class Exp.Date r t' I-- Qu7 0 1 / ,F 3 JOB SITE I APN LLJ83'1£45 D3 ! 1!e t ADDRESS 19 7'i30 'A ;1+` - - Y 1-. C = ,C ✓•°' OWNER CONTRACTOR/DESIGNER/EN (NEER CD Z r` /Date Signature of Contractor_ .co o 7 ' 1 4/ vf PETERSON C L Si RIVENS C014M.UC170M I C OWNER-BUILDER DECLARATION J U (CD r ^0 i i)s( PALhM RID fC'. v 1 QUO YUCCA ROAD W I hereby affirm under penalty of perjury that I am exempt from the Contractor's r a LAQUIN'1'A CA 92253 N10UN'TAW(2WER CA 9:4561 License Law for the following reason: Z_ ( ) I, as owner of the property, or my employees with wages as their sole (760)34.8.3327 (,7.L#- TDD compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed RFHUMATTIAT,I O13LF. contractors to construct the project (Sec. 7044, Business & Professionals Code). REMODEL TO MI—AX,0F.WINDOW OPK1,11NO A. 4D ADD NFV#F'WTKDO11W PER, C () I am exempt under Section , B&P.C. for this reason )AWS ST:i: it'. 'Ut3 JEl c l C'A1.0 2001 CDC, (\I Date Signature of Owner ON 0) d < WORKER'S COMPENSATION DECLARATION u2 Z I hereby affirm under penalty of perjury one of the following declarations: REQ fzF& 1OI ET $,AOJ Do Ls FZ p ( ) 1 have and will maintain a certificate of consent to self-insure for workers' X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the O Q performance of the work for which this permit is issued. m Q I have and will maintain workers'compensation insurance,as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this d rn H permit is issued. My workers' compensation insurance carrier & policy no. are: It Z Carrier STATE FUND . Policy No. 016.009447 X1TINKEEP COO'OF C01\f '1RI7Cwr10 N , ?•t 2 ao J (This section need not be completed if the permit valuation is for$100.00 or less). P"N CHICK 1"'`BE 101.000.439-318 $46,80 ( ) I certify that in the performance of the work for which this permit is issued, CONSTRUCTION FFZ 101-,:700_4.18-000 $72.00 I shall not employ any person in any manner so as to become subject to the STRONO MOTION"M-RES117 101.000.241.000 tso workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section'3700 of the Labor Code, I shall forthwith comply with thos"provisions. Date: Applicants s Warning: Failure to secure Workers' Gi mpensn coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to$100,000,in addition to the cost of compensation,damages as provided for in Section 3706 of the Labor Code,interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety ti for a permit subject to the conditions and restrictions set forth on his .• application. 1.Each person upon whose behalf this application is made&each person at =I-TOTAL,COI^LT R1.Tl"71011 AM)PLAN*CHECK $119.30 { whose request and for whose benefit work is performed under or pursuant to d 1:1M PRE-PAM FRE0 $0 00 any permit issued as a result of this applicaton agrees to, &shall, indemnify 50 AnJ 41'17JCTWKIT & hold harmless the City of La Quinta, its officers, agents and employees.2.Any permit issued as a result of this application becomes null and void if F".6 VO E-NOW $I1-9zO work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. ` .i L: }IIIIIIII IIIIIIIIIIIIIIIII I certify that I have read this application and state that the above information is =FJNAN -E !A Ui— ' ' 41 • correct. I agree to comply with all City, and State laws relating to the building CFRi IE construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ' / / 6 RECEIPT D E y BY i DATE FI ALED INSPECTOR e ✓ Signature (Owner/Agent)_ —, 1/ Date ' c' U ! 3 INSPECTION: RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms&Footings — Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K.to Wrap F.A.U. Framing Z Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans&Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall-Int.Lath _ Final Final —o o POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover I Equipment Location Underground Electric i Underground Plbg.Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster F Sewer Lateral Pool Cover t Sewer Connection Encapsulation Gas Piping , Gas Test I Appliances 1 Final COMMENTS: Final Utility Notice(Gas) ELECTRICAL APPROVALS Temp.Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp.Use of Power Final Utility Notice(Perm) IIIIIII VIII I I VIII IIII 424 IE A' P.O. BOX 1504 No.. 002920 Building 79"7 78-105 CALLE ESTADO Address LA QUINTA,CALIFORNIA 92253 Owner &=rim 0M*W7 BUILDING: TYPE CONST. OCC.GRP. Mailing Address 75-005 C=rttrV a.Ub D'• A.P. Number City Zip Tel. .Pm Deseft 92260 568-2828 Legal Description Contractor Project Description Address 597 mil' rW*8 Ra CityZip Pa,m 3 £2 320-088 State Lic. City ✓?<Classif. 53-426-476 Lic.# 915 Sq. Ft. No. a No. Dw. Arch:, Engr., Size Stories Units Designer New Q 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(commencingwith Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. y % _ SIGNATURE DATE OWNER-BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractors License Law for the following 20.000.00 f ©Qn e1 reason: (Sec..7031.5,Business and_Professions Code: Any city or county which requires a- - s s V 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 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 - for the alleged exemption. Any violation or Section 7031.5 by'any applicant for a permit Plan Chk. Depp . - subjects the applicant to a civil penalty of not more than five hundred dollars($500). Plan ChkBBI • x ❑I,as owner of the property,or my employees with wages as their sole compensation,will . . 5 C[ / do the work,and the structure is not intended'or offered for sale.(Sec.•7044,Buisness and COf1St. . ysu 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, Mech. 16.00 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 Electrical 20.00 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 struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law .j does not apply to an owner of property who builds or improves,thereon, and who contracts for S.M.I. •t such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) Grading ❑1 am exempt under Sec. B.&P.C.for this reason 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.3800,Labor Code.) Policy No. Company 0 Copy is filed with the city. O Certified copy is hereby furnished. TOTAL 1 T11.16 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 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 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 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.) 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. 2-12-87 I certify that I have read this application and state that the above information is correct.. Issued by: Date Permit 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. Validated by: Signature of applicant t Date Mailing Address Validation: City, State, Zip A 7 5 4 9 2 19 % 9. 16 CK HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO.FT.® $ UNITS 2ND FL. SO.FT. YARD SPKLR SYSTEM POR. SO.FT.p MOB]LEHOME SVC. BAR SINK GAR. SO.FT.® POWER OUTLET ROOF DRAINS CAR P. SO.FT. DRAINAGE PIPING WALL SO.FT. DRINKING FOUNTAIN SO 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 EN7 SHOWER BOILER B.T.U. SO.FT.®c BATH TUB SO.FT.®c WATER HEATER MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®1 Na c SEWAGE DISPOSAL SO.FT.GAR®3/ac HOUSE SEWER GAS PIPING PERMIT FEEPERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST.FEE ELECT.FEE SMI FEE PLUMB.FEE I- I 1 1 F - I 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 APP./EOUIP. REINF.STEEL GAS(FINAL) TEMP.POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING LUMBER GR. FINAL INSP. cu.yd. FRAMING FINAL INSP. $ plus x$ _$ ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS. GARDEN WALL FINAL IIIIIIIIVIIIIIIVIIIIIII 43 IE 4 P.O. BOX 1504 No. 002567 Building 78-105 CALLE ESTADO Address 74-711 ArronlA pal lrrwr LA QUINTA,CALIFORNIA 92253 Owner BUILDING: TYPE CONST. OCC:GRP. Mailing Address 7S.005 coLv*ry c>b Drive A.P. Number " City JZip I.Tel. Legal Description Contractor Project Descriptions Pte+ 3 C Natuffu1 maztg. ard land Address PIM im C City Zip Tela Sam State Lic. City 3478 &Classif. Lic.# Sq. Ft. No. No. Dw. 2RA134 328 Size GM 696 Stories Units Arch., Engr., Designer New p; 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(commencingwith Section 7000)o I Division 3 of the Business and Professions Code,and my license is in full force and .effect .'1 N. /T - • /",. _/ . SIGNATURES T'- - - DATE "OWNER-BUILDER DECLARATION Estimated Valuation I h reby,af4rm 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 ! .. 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;Ucense 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 subjectstheapplicant to a civil penalty of not more than five hundred dollars($500). " 0 1,as owner of the property,or my employees with wages as their sole compensation;will Plan Chk. Bal. 593.98 do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and COr1St. ' 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, Mech. provided that such'improvements,are not intended or offered for sale. If, however, the building + uu or improvement is sold within one year of completion, the owner-builder will have the burden Electrical 1-4111.73of proving that he did not build or improve for the purpose of sale.) 0 I,as owner of the property,am exclusively contracting with licensed contractors to con- 'Plumbing 144.50 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. 14.81 such projects with a contractor(s)licensed pursuant to the Contractor's License Law.) Grading D 1 am exempt under Sec. B.&P.C.for this reason Driveway Enc. Date Owner Infrastructure 2.101M.00 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.3800,Labor Code.) Policy No. Company ❑Copy is filed with the city. . O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS, .WORKERS'COMPENSATIONINSURANCE (This section need not be completed if the permit Is for one hundred dollars ($100) valuation orless.) — 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 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 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.) 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 Permit 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. Validated by: Signature of applicant 1 O Date } f Mailing Address Validation: City, State, Zip A 6 3 1 4 9 10 X665. G2 R HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL FEESjjk NO. PLUMBING FEES 1ST FL. SO.FT.® $ UNITS 2ND FL. SO.FT. YARD SPKLR SYSTEM 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 SO 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. SO.FT.®c BATH TUB SO.FT.®c WATER HEATER MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®11/4 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 EPL.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 APP./EQUIP. REINF.STEEL GAS(FINAL) TEMP.POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING LUMBER GR. FINAL INSP. cu.yd. FRAMING FINAL INSP. $-Plus-X$-=$ ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SO U N D FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL - INSPECTOR'S SIGNATURES/INITIALS. GARDEN WALL FINAL