Loading...
0201-076 (MISC)79762 Arnold Palmer r LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT# 00 U) I hereby affirm under penalty of perjury that I am licensed under provisions of i- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION Lor (j.2p -Q7fi TRACT 04 W Professionals Code,and my License is in full force and effect. {` { 1 f, n O =) M License# Lic.Class Exp.Date r- Q 11) JOB SITE APN r W 7315? B 3/3,1 f{}3 ADDRESS ARNOLD} .1 ,M". 7 / 7(i — - - Z r- Date ` ' `-Signature of Contractor i 1 OWNER CONTRACTOR/DESIGNER/EN INEER O f` r- I.- C:) OWNER-BUILDER DECLARATION PGA I '1RSI IT)FNI AL DEL MAR P 1 :MC C'1 'WJ Al.CO1, jl.3,1 W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's 110 DOx 1060 2533 S01MI COALrf 13101-I WAY U17-250 ~ a License Law for the following reason: LA Qt71N'I'A CA 92253 CAltDiW FiYTH3:'SWA. (!& 92007Z_ ( ) 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 *"16Cij; f>'1^ 00 CE31J$ 5823 sale(Sec.7044,Business&Professionals Code). USE OF PERMIT ( ) 1, as owner of the property, am exclusively contracting with licensed IIIIIIIIIIIIIIIIIIIIIIIII contractors to construct the project (Sec. 7044, Business & Professionals 14.11 `11 AMAJ(1S 29 Code). IE u') I am exempt under Section , B&P.C.for this reason 81111,rNNOt 19.740W7 ,79•754,79.-AI6,-X433• VOLUNMA Y'' O NDate Signature of Owner STRL1C"I' MAL MODWIVATIONS a)CL Z WORKER'S COMPENSATION DECLARATION D cc I hereby affirm under penalty of perjury one of the following declarations: U-) H O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' VALUATION 20,000,00 I,a X W IL compensation, as provided for by Section 3700 of the Labor Code, for the m Q performance of the work for which this permit is issued. Q U 1 have and will maintain workers'compensation insurance,as required by Q LO Q Section 3700 of the Labor Code, for the performance of the work for which this Il Z permit is issued. My workers' compensation insurance carrier & policy no. are: cb 5 Carver Tr ATF TfUND Policy No. 046011IMT00094I3 19w .1E'1, TF-D COST 0311"C 111811MMON i3,E .t3U O g (This section need not be completed if the permit valuation is for$100.00 or less). f1A" '.F'1s'401Mh/IA 2 ( ) I certify that in the performance of the work for which this permit is issued, C'•COG TRUCTION VER 101-000-418-000 $1.07,00 1 shall not employ any person in any manner so as to become subject to the 5'1'N{aW1 MOTION FRE-R.9310 I01-000-241-000 X3.00 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. Date: Applicant— Warning: pplicant 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. 4 d 1.Each person upon whose behalf this application is made&each person at t whose request and for whose benefit work is performed under or pursuant to "IRTA-U)TAL 40NMI UCTIfKAX•D ?4VN CF OCIO; $204 00 any permit issued as a result of this applicaton agrees to, &shall, indemnify J q l PRr,,PAT 1-UK8 $4,00 & 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 work is not commenced within 180 days from date of issuance of such TorA'PIMMYFEF DUF Y"Tow fiX319.00 permit,or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. RECEIPT DATE BY— DATE FI ALED V INSP CT Signature (Owner/Agent) t. 1 - Date - f tia . ' - -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 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 POOLS - SPAS BLOCKWALL APPRovALA Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg.Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K.for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMS 'I,,,,. 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) li , I IIIIIIIIIIIIIIIIIIIIIIIII 304 IE A' P.O. BOX 1504 No. 002702 Building 79-762 �IA Palm= LA QUINTACCCALIFORNIA 92253 Address Owner Mailing ��' BUILDING: TYPE CONST. OCC.GRP. Address 75-005 Cb+ tWiyLm' A.P. Number City Zip Tel. - Pal � 92260 568-2828- Legal Description Contractor Project Description MA WM PHMM 13 H flatknal Awe iM rA-nd PIM 40 ¢ Address 'City Zip Tela State Lic.`""" ' City EIM 3142 &Classif.288130 Lic.# 2$ Sq. Ft. No. No. Dw. Sized. Stories Units Arch.,Engr., Designer New Q. Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State - Lic.# - LICENSED CONTRACTOR'S DECLARATION I hereby affirm that.1 am licensed under provisions of Chapter 9(commencing.with Section 7000) f Division 3 of the Business and Professions Code,and my license is 1p°full force and o effect. . t,X/ St' ��' w,. I. Y ! �///�Z­ SIGNA—UREAy DATE 7r OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation i U .00 reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 39 permit to construct, atter, 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 live hundred dollars($500). Plan Chk. Bal. 564.19 ❑1,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 Const. 678.00 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 orimprovement 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.) ❑1,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing 1A0,513 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 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 13tiQ.>i1l? 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 O Copy isfiled with the city. ❑Certified copy is hereby furnished. TOTAL ZaSRj1 ? 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 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 This is a'building permit when properly filled out,signed and validated,and is.subject to .FINAL DATE INSPECTOR 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__I] efmlt 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 p urposes. f ! Validated by: Signature of applicant 'I!. -Date Mailing Address r' 3' `"� Validation: City, State, Zip A 6 7 2 8 1114 8u 17 Cti HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL S 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. 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 WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY 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 STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR SETBACK ROUND PLUMBINC0`/7 UNDERGROUND A.C.UNIT COLL.AREA Af—�SLAB GRADE I9 oma- OUGH PLUMB. /? ? BONDING HEATING(ROUGH) STORAGE TANK FORMS `SEWER OR SE�TI At� UGH WIRING 3 DUCT WORK ROCK STORAGE (/s rvLIND.REINF./1 / ( GAS(ROUGH)e—/METER LOOP HEATING(FINAL) OTHER APP./EQUIP. REINF.STEEL /� 19 1p GAS(FINAL) 1C TEMP.POLE 5� GROUT WATER HEATER SERVICE AL INSP. / BOND BEAM WATER SYSTEM GRADING LUMBER GR. FINAL INSP.$ cu.yd. RAMING 3 fY ? P. /o $ plus x$ _$ WOOFING 0,7clC d o D REMARKS: IC To VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 3 MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL :d Page_�of IIIIIIIIIIIIIIIIIIIIIIIII 3, DAVE STEAVENS ' Inspection Services PROJECT�C.,A W �`t- G c _ 5 PROJECT # s vo.? • o ,rte ADDRESS IR"'7''_'�, �G.."i'S y "i 4'�' CLIENT 1�G A t.J C S T W o E} f1 tJaL� tm4.ML,z ,14 t.1 "T DATE ou3 BLDG.PERMIT# ARCHITECT _ b„•' 0U A A szc%4 , ENGINEER If,o r.,l 'Sfl Jc, -e W<. CONTRACTOR CL 1"0412 N t r,:•c INSPECTION TYPE INSPECTION REPORT t r �.� 1111115"t 4SQu:%tJ stet • ht tXuas &AJ sUc:c} 1.A! -rb f_c"J CZ tn,ALt,. � t �' .'c �,�.� 15 •f3. /. �' '�, 14 is • A , #5 s Lam'•u 5 L- 7vx ft-3� 3 � i ..� I t. � ���r �R1 � �3Lc�G.�l�aIG� J? •3S s �.* ?v5 � �tJnr.�tt t � AT /MRS [ill M�r�tJl L. .� r`1'S i s - 1 ricog rn r i Gr L. '"!Cls A -.2 S 5 L o�7" N -) r LrA I(- rht'iN — f 7 5 • � *' �i2AM� LvcK/,J '�5 •.�y S ' �cjwt `�,T�: . CERTIFICATION OF COMPLIANCE:To the best of our knowledge,all of the reporte9work, unless otherwise noted, . . :. �substantially oo lie$with 8pproved plans,specifications and applicable sections of the building codes.This report covers t�lO Work inspected only and does not constitute engineering opinion or project control. CERT.NO. INSPECTOR NAME _ e 1 rt J t y ' DATE INSPECTOR SIGNAn c ..