0201-076 (MISC)79746 Arnold Palmer
LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
I hereby affirm under penalty of perjury that I am licensed under provisions of
!— Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION Lor {.t I{y1..+)76 TRACT
04 W Professionals Code,and my License is in full force and effect. I :
License# Lic.Class Exp.Date •- 1 = r= lC,it3,4)O
Odr JOB SITEIX
" APN
ADDRESS
)'A.tJIKR 7
_ ..
Z Date f ! ` -Signature of Contractor OWNER CONTRACTOR/DESIGNER/EN INEER
D O ~
0 OWNER-BUILDER DECLARATION P61,0",. - ;n : ;.,..,
W ds ) 9[),I`Td I'I1 I.. EL. .3XR FAC U.'Z :'+.: F'1!t.i-i.! E.,('0.Pl'r%f`. 'tt.F V
H a I hereby affirm under penalty of perjury that I am exempt from the Contractor's ±ic; S;;; t (i ),; 3 ;t :} Tt`FT C'`;>ltitrf f.l)_C,;; ryvr,;! ;;►':)_ .1$0
W License Law for the following reason:
Z ( ) 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,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). _
Cl)
O I am exempt under Section B&RC.for this reason tctrlt..: 1Nf:4.19• 79-17624'79,75 t; , i 6,:-,',73 • 'VOLON'F.`,. :.'tr
O N Date Signature of Owner `I'i?lir }'r.iEti l A9c)f-.IVIV.A'I'!ON"i
0)a Z WORKER'S COMPENSATION DECLARATION
io Q cr I hereby affirm under penalty of perjury one of the following declarations:
r F- O O 1 have and will maintain a certificate of consent to self-insure for workers' 't.P,).1f 't If?ef ;tt,E1Gb,0U t,
X W : 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 a Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
aro t'Ph'I't :I !t1E: n1fRllltj)1i) lll it',5 CY YVIAIXY1 l)t:"M!'(W A{)40)100
g (This section need not be completed if the permit valuation is for$100.00 or less). V I•"RMI E b.)IR,1140MMARN
( ) I certify that in the performance of the work for which this permit is issued, ta:p.t ';RUC' ),ji,7 GEES IN-000-418-000 WA
1 shall not employ any person in any manner so as to become subject to the :'t'!;Ctt+ti.t M07,i,-,N F'I"r• R SID 'I01-(300_2.4 I-(!(!U 44.40
workers' compensation laws of California, and agree that if I should become
3 subject to the workers'compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those,provisions. j
Date: Applicant
Warning: Failure to secure Workers'Compensation 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
for a permit subject to the conditions and restrictions set forth on his
application. t /
1.Each person upon whose behalf this application is made&each person at
whose request and for whose benefit work is performed under or pursuant to t rig-'I=t:a7"i',i:,f,?(•Dl bf)1{I:1(Til 04'.AN] P*z.6,.14 c.ifko?` 2di1 0(i
any permit Issued as a result of this applicaton agrees to,&shall, Indemnity
I., :13 f'1i1,.•}'A).f)1':Is."e?3 °!I!.nC!
& hold harmless the City of La Ouinta, Its officers, agents and employees.
2.Any permit issued as a result of this application becomes null and void If
work Is not commenced within 180 days from date of Issuance of such Tt')'.!'AJ,I'7?: .M31"FM;k!:fi'I)i1F;NOW
permit,or cessation of workfor180 days will subject permit to cancellation. IIIIIIIIIIIIIIIIIIIIIIIII
I cert) that I have read this application and state that the above Information Is 13
• correct. I agree to comply with all City, and State laws relating to the building IE
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.%'
RECEIPT DATE BY DATE FI ALED INSP CT
Signature (Owner/Agent) 7 Date / 7 ! / ! _ 6.,Z
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms 8 Footings Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K.to Wrap F.A.U.
Framing 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
BLOCKWALL APPROVAI_4 steel POOLS - SPAS
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equiomert location
Underground Electric
Underg,ound Plbg.Test
Final Gas Piping
PLUMBING APPROVALS Gas Test
!=!ecaric Final
Waste Lines Heater Final
:'Vater Piping Glurrbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans ~0.{.for Finish Platter
Server Lateral Pool Cover
Sewer Connection Encapsulation
Gas Piping
Gas Test
Appliances —"
"Fila)
COMME TS:
i Final
Utility Notice(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
t Low Voltage Wiring
I Fixtures
=Main Service
L Sub Panels /
Exter"'or Receptacles
G.F.1.
Smoke Detectors
Temp.Use of Power
1 Final
Utility Notice(Perm)
IIIIIII VIII III VIII IIII 1144
IE 002704
P.O. BOX 1504 N N Q.
Building 78-105 CALLE ESTADO
Address 79-746 A=1d Palmer LA QUINTA,CALIFORNIA 92253
Owner
Mailing m BUILDING: TYPE CONST. OCC.GRP.
Address 75-M5. Mint7v Club Drive A.P. Number
CityZip Tel.
Palm l92260 568-2R29 .. Legal Description
Contractor Project Description TM 171 M PfiA.E 33 R
fifwsAl PlZm 10 OR
. . Address
13am
City Zip Tel.
State Lic. City EM
&Classif.28913Q Lic.# 3?_ Sq. Ft. 22"12 No. No. Dw.
Arch., Engr., Size W2 Stories Units
Designer New Nt Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSED CONTRACTORS DECLARATION
I hereby affirm that,l am licensed under provisions of Chapter 9(commencing with Section
70 130)of Div'Sion 3 of the Business and Professions Code,and my license is in full forc:wAnd
effact.
SIGNATURE
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a $-144,517.00
permit to construct, alter, improve, demolish, or repair any structure, prior to itsissuance 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' Plan Chk. De
for the alleged exemption. Any violation of Section 7031.5 by'any applicant for a permit p
subjects the applicant to a civil penalty of not more than rive hundred dollars($500).
O I,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal. 462.89
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and545.50 r Wit,Wit,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, w
CCA!!
provided that such improvements are not intended or offered for sale. If,however, the building Mech. «7«t X00
or improvement is sold within one year of completion, the owner-builder will have the burden Electrical 102.17
of proving that he did not build or improve for the purpose of sale.)
❑ I,as owner of the properly,am exclusively contracting with licensed contractors to con- Plumbing 228.
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 50
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 2,000.00 -
WORKERS'
000.UQWORKERS'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. ❑Certified copy is hereby furnished.
TOTAL 3„303,90
CERTIFICATE OF EXEMPTION FROM REMARKS
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 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
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 UD" ermit
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- r
mentioned property for insspe,ection purposes. f/ y Validated by:
!
Signature of applicant - + s Date *' -`
Mailing Address r'"j Validation:
City, State, Zip
A 6 7 3 3 11 14 33 ., 396 Ch
HARD COPY
r.
CONSTRUCTION ESTIMATE NO. ELECTRICAL NO. PLUMBING FEES
1ST FL. SQ.FT.® $ UNITS
2ND FL. SQ.FT.
YARD SPKLR SYSTEM
POR. SQ.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. 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. SQ.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
A SETBACK X44ROUND PLUMBI�t!�/ / UNDERGROUND A.C.UNIT COLL.AREA
ry�jSLAB GRADE _+<g<2 /ROUGH PLUMB ` BONDING HEATING(ROUGH) STORAGE TANK
tr FORMS T t)6EWER OR SEPTI T K3 6OUGH WIRING?1/0 bi DUCT WORK ROCK STORAGE
FOUND.REINF./ i. GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APPJEOUIP.
REINF.STEEL A7414S(FINAL) V—f%7 TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM J
GRADING
LUMBER GR. FINALINSP.
cu.yd.
14FRAMING i\ C SINAL INSP. $ plus x$ _$
0/,!/ROOFING a' /�g / , REMARKS:
VENTILATION / O/e Td k-,ff P yr a/ �(i4/
FIRE ZONE ROOFING 'n�./ (,v ny � 7,
FIREPLACE ►►✓✓ ((
SPARK ARRESTOR -
GAR. FIREWALL
LATHING J 2�
MESH
lam-CASULATION/SOUND J Y
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
IIIIIIIIVIIIIIIIIIIIIIII 12Tihf "
'ENo. x.3258
4 4a
P.O. BOX 1504
Building 79-746 Arnold Palmer 78-105 CALLE ESTADO
Address LA QUINTA,CALIFORNIA 92253
Owner Ms, d.Alan11artella
Mailing BUILDING: TYPE CONST. OCC.GRP.-
Address Same A.P. Number
City Zip Tel.
La Quinta, CA 92253 1 771-1111 Legal Description
Contractor Project Description Enclose Atruim
Cal Tech Builders
A:>Z_�11 Ave. Velasco
city Quinta, CA zip 92253 Tela 564-2309
State Lic. City
&Classif. B 594090 Lic.If 402 Sq. Ft. No. No. Dw.
Size 108 Stories Units
Arch., Engr., Paul Scott Andersor.
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Ad lou. Sox 277 Tel. 564-5038
City Zip State
iia Quinta, CA 92253 Lic.# C10792
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that.I am licensed under provisions of Chapter 9(commencing with Section
,70tX1)of Division 3 of the Business and Professions Code,and my license is in full force and
SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation $8,424.00
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
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 of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant 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. 70.20
do the work,and the structure is not intended or offered for sale.(Sec. 7044,euisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who Const.
'-i 1013, Q
n0 _
builds or improves thereon and who does such work himself or through his own employees, Mech. 21.00
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 18.28
of proving that he did not build or improve for the purpose of sale.)
❑ 1,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 •
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I..
such projects with a contractors)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
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 j • - ` V. ' -�
❑kCopy ed with the city. ❑Certified copy is hereby furnished.
TOTAL 21 .3
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
Ihereby 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 P�•ty/Line
Lender's Name /
Lender's Address
This is a building permit when properly tilled out,signed and validated,and is subject to FINAL DATE IS ECT1216
expiration if work thereunder is suspended for 180 days. %
AA
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: \ e
Signature of applicant Date `
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SO.FT.p $ UNITS
' YARD SPKLR SYSTEM
2ND FL. SO.FT.p
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. I SO.FT.® DRAINAGE PIPING
WALL SO.FT.® DRINKING FOUNTAIN
SO.FT.
URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
I
NOTE:Not to be used as property tax valuation FLOOR DRAIN
i
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
i
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,TEMIPERM 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 PL.CK.FEE CONST.FEE ELECT.FEE SMI FEE PLUMB.FEE
i
I
STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR
i
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. L / AS(ROUGH) /_ y,/ METER LOOP HEATING(FINAL) OTHER APP./EQUIP.
REINF.STEEL a 1 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
INSULATIONISOUND
FINISH GRADING
INAL INSPECTIO
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL