0208-124 (RR)Building 39 Arnold Palmer
LIk.tIVJtU 4.01111 HAI- I UH Ur-%,LHHHI IUI14
that I licensed under of
PERMIT #
BUILDING PERMIT
'
I hereby affirm under penalty of perjury am provisions
0208-124
F-
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
DATE VALUATION LOT TRACT
517,928.00
wProfessionals
Code, and my License is in full force and effect.
th
License # Lic. Class Exp. Date
APN
`r'
LuSITE
w
235717. C-39 B HIC 1/31/03
ADDRESS BLDG. 39 ARNOLD PALMER
-
OWNER CONTRACTOR / DESIGNER / ENGINEER
Z
Date Signature of Contractor
h
OWNER -BUILDER DECLARATION
PGA WEST RESIDENTIAL HOMEOWNER'S E WESTERN PACIFIC ROOFING
U r-
PO BOX 1060 3462 LA CANIPANA WAY
W
Cl-
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
LA QUD!4TA CA 92253 PALM SPRINGS CA 92262
Z
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
(760)416.5877 CBL# 4293
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
GENERAL B=ING IIIIIIIIIIIIIIIIIIIIIIIII 68
11111111M
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
BLDO.39; 79-682,79-690,79-698,79-706: RE -ROOF WITH
c
O I am exempt under Section , B&P.C. for this reason
POLYURETHANE FOAM di ACRYLIC C"•t ATINCI Rt30FI140 SYSTEM -;-
N
ON
Date Signature of Owner
rn
Q
WORKER'S COMPENSATION DECLARATION
2 Z
Q OC
I hereby affirm under penalty of perjury one of the following declarations:
VALUATION 17,923,00 LS
O
() 1 have and will maintain a certificate of consent to self -insure for workers'
W LL
compensation, as provided for by Section 3700 of the Labor Code, for the
J Q
performance of the work for which this permit is issued.
G U
( ) I have and will maintain workers' compensation insurance, as required by
USection
f
3700 of the Labor Code, for the performance of the work for which this
LO
0) Id—
permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z
Comer STATE FUND Policy No. 0457624-02
ESTEVIATED COST OF CONSTRUCTION
17,928.00
rrD a
PERMIT FEE SUMMARY
g
(This section need not be completed if the permit valuation is for $100.00 or less).
REROOF FEE 101-000-418-000 $30,00
( ) 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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
3
Code, I shall forthwith comply with those provisions.
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.
1. Each person upon whose behalf this application is made & each person at
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$30.00
whose request and for whose benefit work is performed under or pursuant to
LESS PRE -PAID FEES
$0,00
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& 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
TOTAL PERMIT FEES DUE NOW
$30.00
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 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 FINALED
INSPECTOR
Signature (Owner/Agent) Date
�— IIIIIIIIVIIIIIIVIIIIIII 69
IE 4
P.O. BOX 1504
No. 002986
Buildingti 78-105 CALLE ESTADO
Address 79'-683 ld F6_1M=. LA QUINTA, CALIFORNIA 92253
Owner _
Mailing
Address ;.ice- as Z ove
City Zip Tel.
%33 Quinu, 11M 92253.
2,LenT1s..
Address .
577 Sar-
City .. _. Zip
Palm wings, CA 92262
State Lic.
& Classif. 425476
Arch P.—
Designer
Address
12.0-€)688
City
Lic. # 915
Tel.
City Zip 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
Teffect. . . r "�, . - .. , 7
SIGNATURE DATE
OWNER -BUILDER DECLARATION
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
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 .tor 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.)
O 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.)
❑ 1 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. 3800, 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 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
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, Civil Code.)
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 relaling.tobuilding
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
HARD COPY
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description =
Sq. Ft. No. No. Dw.
Size- Stories • Units
New [9 Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation .$200000
22.00
%PERMIT -
kt
AMOUNT
Plan Chk. Dep.
1.44
Plan Chk..Bal..
95.22
Const.'
146.50
Mech.
16.00
Electrical
22.00
Plumbing
14.00
S.M.I.
1.44
Grading
Driveway Enc.
Infrastructure
FINAL DATE
INSPECTOR
Issued by:
Date 3/IU87 Permit
Validated by:
Validation:
TOTAL
A 7 5 2 2
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
INSPECTOR
Issued by:
Date 3/IU87 Permit
Validated by:
Validation:
A 7 5 2 2
3 13 19516 it
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. Q
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ® c
BATH TUB
SQ. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 14/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
VENTILATION
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
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
t
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
70
IE
Buildin
Address 79-5$3 Arnold Pal=r
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Mailing
Address 75-005 OUnfrY CU6 ))riyp
City Zip Tel.
-Palm � 92260, 5fi8 2$29 .
Contractor
Address
No. 002570
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description EM K` TIME 3 C
Plan 100 CMZ
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.
CERTIFICATE OF EXEMPTION FROM
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
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, Civil Code.)
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 * � h � + t of �• /,' Date
Mailing Address
City, State, Zip f v
HARD COPY
TOTALI:�*Q
REMARKS
ZONE:
BY:
Minimum Setback Distances:
City'
Zip
Tel. -
Rear Setback from Rear Prop. Line
State Lic.
CityE
34U
& Classjf. 298136
Lic. # 328
Sq. Ft.
GM 696.
No. No. Dw.
Validated by:
Size •
Stories Units
-Arch., Engr., .._
A6313
Designer
New IR 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 Section
7000) of Division 3 of the Business and Professions' Code, and my license is in full force and
effect. , i .t. % I. . • �r i% f,.
SIGNATURE:a r x " +" t DATE
/UI
VOWNER-BLDER DECLARATION
hereby I from for following
Estimated Valuation
-
' j, _
I affirm that am exempt the Contractor's License Law the
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
G V .
211A38.00
�a.A�
perinit 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 Any Section 7031.5 by 'any. for
Plan Chk. Dep.
-
alleged exemption. violation of applicant a permit
' subjects the applicant to a civil penally of not more than five hundred dollars ($500):
Plan Chk. Bal.
t� A•
J7.78
593.918
❑ 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�17044, Buisness and
Const.
13.00
Professions Code: The Contractor's License Law does, not apply. to an owner of,properfy who
builds or improves thereon and who does such work himself or through -his own employees,
Mech.
_�(� /dry
- provided that such improvements are not intended or offered for sale. If, however, the building
„yta��Q
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
144.50
-struct the project. (Sec. 7044, Business and Professions Code: The Contractor's: License Law
does to builds improves. thereon, for
S.M.I.
not apply an owner of property who or and who contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
it!>►GiA
g
,
O 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
❑ Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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
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, Civil Code.)
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 * � h � + t of �• /,' Date
Mailing Address
City, State, Zip f v
HARD COPY
TOTALI:�*Q
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
INSPECTOR
Issued by:
Date 9-1-0-66 Permit
Validated by:
Validation:
A6313
9 10 566762 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EES;Aft
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT.
POR. SO. FT. @
GAR. SO. FT. @
CAR P. I SO. FT.
WALL SQ. FT.
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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/a•::
HOUSE SEWER
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JLECT. 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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
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
LIL,LIVJtU L UI4 1 HAL, 1 UH Ur_L LNHNI IUW
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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
235717 C-39 B HIC 1131/03
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I 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.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier' & policy no. are:
Carrier STATE FUND Policy No. 0457624-02
(This section need not be completed if the permit valuation is for $100.00 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, 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 those provisions.
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.
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
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& 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
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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
0208-124
DATE VALUATION $17,928 00 LOT TRACT
JOB SITE
ADDRESS BLDG. 39 ARNOLD PAL11'IER APN - -
OWNER CONTRACTOR / DESIGNER / ENGINEER
PGA WEST RESIDENTIAL HOMEOWNER'SF'3462LACANTAWAWAY ESTERN PACIFIC ROOFING
PO BOX 1060
LAQUINTA CA 92253 PALM SPRINGS CA 92262
(760>416-5877 CBL4 4293
USE OF PERMIT
GENERAL BUILDING
BLDO.39; 79-6479-690,79-698,79-706: RE -ROOF WITH
POLYURETHANE FOAM ∾RYLIC; COATING ROOFING SYSTEM
VALUATION
17,923,00 LS
ESTIMATED COST OF CONSTRUCTION 17,928.00
PERMIT FEE SUMMARY
REROOF FEE 101-000-418-000 530,00
SUB -TOTAL CONSTRUCTION AND PLAN CHECKI $30.00
LESS PRE-PAIDFEES $0,00
TOTAL PERMIT FEES DUE NOW 1 $30.00
IIIIIIIIIIIIIIIIIIIII1 13
IE
RECEIPT I DATE I By I DATE FINALED I INSPECTOR
IIIIIII VIII III VIII IIII 14
IE
DAVE STEAVENS
Inspection Services
PROJECT %A uk S i L eaLta-bS
ADDRESS y / ? -r ! b
BLDG. PERMIT #
ENGINEER u rJd eAj c
INSPECTION TYPE
Page I of
PROJECT # 47 v4.2 - 0 9
CLIENT &,4 141 c %r AtvA
DATE I/ .214 NC .J w v 2
ARCHITECT CvtdA Al�CM
CONTRACTOR"st )ACtizic
INSPECTION REPORT
17-1-&g2.Gy90.r:� . 706 f/r A&,C.003 J°%r��•�c04 464yeW J7 �ir�+Al 50
0
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,
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- 7 4 - s Z 70 `9 —fd s sc,UW s
tai NtLS &.ycwjjG 30,;r -A- . Ayffrt,,.)
AT' w C. 5T $6 arc to t i>
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
O=corVies with approved plans, specifications and applicable sections of the building codes. This report covers
of W4 work inspected only and does not constitute engineering opinion or project control.
CERT. NO. �� 7 3 Sri INSPECTORNAME
DATE _�I �unl C n7t�4 INSPECTOR SIGNATURE
r Page i of
DAVE STEAVENS
Inspection Services
0 -s
PROJECT Pb A WES_r_1.LF6e.1J405 PROJECT # r!:P70Q A • o � .
ADDRESS L C► / C 4/7 CLIENT 6A tJ tS`r W& A
BLDG. PERMT #
ENGINEER hx1U0 5AU(# 1AA—
INSPECTION TYPE
DATE 7.r'w!tr ;awZ
ARCHITECT GO LZ A Ail c &-4
CONTRACTOR CL OWter yo'(..
INSPECTION REPORT
&4a4i c•r.A5•"I ! t%.ue-1i13%. lis'3'S•S. LP -r- q -
'De -rink L -ss - !. 3. 4. 04A. t8)!S- -1 - LOC -k-, $de-, A• 3+� Lw�o s A•��5- �'�M�
jt_ ic_• 3q's - �. 7,�
i_af"rL-
{�'Sq--q y0 4,5g _974. 29V 1>34o ,'1*
NC- s A I t..'5 " r. a 2A. #4 VA 1-5-1- PA#, 74 IIJIkL,. A _j h 14-N/
fl i
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
�esubstantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
,W1ffio&10vd#he work inspected only and does not constitute engineering opinion or project control.
CERT. NO. —fir 7 "j ' J� INSPECTOR NAME
DATE 17 7 v ax g7 e k) Z. INSPECTOR SIGNATURE
IIIIIIIIIIIIIIIIIIIIIIIII 15
IE 44
P.O. BOX 1504
Building 79-700 Arnold Palmer 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Landmark band/PGA West
Mailing
Address 79-811 Ave 54
City Zip Tel.
La Quinta, CA 1 92253 564-4463
Contractor
ress
City
Zip
Tela
State Lic.
City
133
& Classif.
Lic. #
Arch., Engr.,
Designer
Address
Tel.
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed uQder provisions of Chapter 9 (commencing with Section
.,7000) of Division 3 of the Business anal Professions Code, and my license is in full force and
,effect
. t f
_SIGNATURE \. DATE
OWNER(BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 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
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.)
❑ 1 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. 3800, Labor Code.)
Poli "No. Company
NCopy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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
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, Civil Code.)
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. 129T5
BUILDING: TYPE CONST. OCC. GRP.
,A.P. Number
,Legal Description
Project Description Electric pedestal
Arnold Palmer Course
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
stimated Valuation
;800.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
33.50
Plumbing
.S. M. 1.
Grading
Driveway Enc.
Infrastructure
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
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO. FT. @
I
I
WALL SO. FT. ®
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
=$
URINAL
SO. FT.
FRAMING
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
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
SPARK ARRESTOR
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
INSULATIONISOUND
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
FENCE FINAL
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
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.IEGUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSPS/-/
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
16
IEBuildin
I
Address 79-705 Arid 1d Pabwx
Owner
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
. spun 3se cam.
Mailin
Address 75-00!0 comtry club Pc}ry
CityZip Tel.
. . � �� t 32260 568--282-
Contractor
_ . .Address. _
577 IY des ectad
State Lic. V _ City
& Classif. • 42& 476 Lic. # appUed
Arch., Engr.,
Designer
Address Tel.
CityZip 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.
SIGNATUPL1 - - DATE
" OWNER -BUILDER DECLARATION
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
the provisions of the Contractor's LicenseUaw, 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, Buisriess 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.) - -
O 1 am exempt under Seca B. & P.C. for this reason
No. 002853
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Project. Descriptions
Driveway Enc.
Date Owner
Infrastructure
Front Setback.from Center Line
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
or less.)
certify that in the performance of thg work for which this permit is issued,-) shall not
employ any person in any manner so as to become subject'to'the Workers' Compensatiorl
Laws of California.
Date Owner
Rear Setback from•Rear Prop. Line
Sq. Ft.
Size -
No. No. Dw.
Stories Units
New Li Add ❑
Alter ❑ Repair ❑
Demolition ❑
INSPECTOR
Issued by:
Date 1-26-87 Permit
Validated by:
Validation:
A 7 1 7 6
1 27
Estimated Valuation
22,€ 00.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk: Bal..
103.02
Const:.
15$.513
Mech.
1-6.00
Electrical
20.00
Plumbing
14iOf)
S.M.I:'
1.52
Grading
NOTICE TO APPLICANT: If, ager 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, Civil Code.)
Lender's Name
Lender's Address
This Is a building permit when properly filled out, signed and validated, and is'subject to
expiration it 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 f Date <j
Mailing Address
City, State, Zip
HARD COPY
ZONE:
Driveway Enc.
Date Owner
Infrastructure
Front Setback.from Center Line
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
or less.)
certify that in the performance of thg work for which this permit is issued,-) shall not
employ any person in any manner so as to become subject'to'the Workers' Compensatiorl
Laws of California.
Date Owner
Rear Setback from•Rear Prop. Line
Side Street Setback from Center Line
TOTAL 313.10
REMARKS
-
FINAL DATE
INSPECTOR
Issued by:
NOTICE TO APPLICANT: If, ager 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, Civil Code.)
Lender's Name
Lender's Address
This Is a building permit when properly filled out, signed and validated, and is'subject to
expiration it 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 f Date <j
Mailing Address
City, State, Zip
HARD COPY
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
INSPECTOR
Issued by:
Date 1-26-87 Permit
Validated by:
Validation:
A 7 1 7 6
1 27
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT. qp
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SQ. FT. ®
OTHER APP.IEQUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN
SQ FT @
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
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
LAUNDRYTRAY
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.
SQ. FT. RESID ® 1 Ya c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/4c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
FPLUMB.FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI 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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL.INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE. FINAL
INSPECTOR'S SIGNATURESIINITIALS.
I GARDEN WALL FINAL
IIIIIIIIVIIIIIIVIIIIIII 17 ��•.
IE 44
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 797()5 Arsxsllc3 ialrre+r rhi _ LA QUINTA, CALIFORNIA 92253
Owner smrim I
Address 75-005 CIburritTy Club trwiVe
CityZip Tel.
PalmD Sert 92200 6&-2823
Contractor
Address .
»
City lZip Tela
No. 002539
BUILDING: TYPE CONST. OCC: GRP
A.P. Number
Legal Description
Project Description P!• WMV �' 3 C
State Lic.
City
_
CERTIFICATE OF EXEMPTION FROM
& Classif. 280130
Lic. # 328
Sq. Ft. No. No. Dw.
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
Size Stories • Units -
Arch., Engr., ' -
Designer
New OQ ' Add ❑ Alter ❑ Repair ❑ Demolition ❑
j.
Address
Tel.
-
City
Zip
State
ZONE: BY: '
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances: '
Lic. #
Front Setback from Center Line
LICENSED CONTRACTOR'S DECLARATION
Rear Setback from Rear.Prop. Line
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of DNision 1of the Business and Professions Code, and my license is in full force and
effect.
Side Street Setback from Center Line
SIGNATURES•DATE
t OWNER -BUILDER DECLARATION
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
Estimated Valuation
.. PERMIT . AMOUNT
'
permit to construct, after, 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 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).
❑ 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 .
Plan Chk. Bal.
Const.'
Mech. .
'
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
-EI@CtflCal - 22.50
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,,or the purpose of sale.)
Plumbing
❑ 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 or property who builds or Improves thereon, and who contracts for
S.M.1. .
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec.- 8. & P.C. for this reason
Grading
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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
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 it work thereunder is suspended for 180 days. i� �3"�y�
I car tlly that I have read this application and state that the above information is correct. Issued by: Date V 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 r 19 -4 9'4 ! � Date f6 //
Mailing Address r/ Validation:
City, State, Zip 1
A 6 5 1 1 1U 13
HARD COPY
2250 R
TOTAL 22.50
_
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, 1 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
comply with such provisions or this permit shall be deemed revoked. -
Minimum Setback Distances: '
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 it work thereunder is suspended for 180 days. i� �3"�y�
I car tlly that I have read this application and state that the above information is correct. Issued by: Date V 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 r 19 -4 9'4 ! � Date f6 //
Mailing Address r/ Validation:
City, State, Zip 1
A 6 5 1 1 1U 13
HARD COPY
2250 R
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP.IEQUIP.
DRAINAGE PIPING
CAR P. SO. FT.
TEMP. POLE
WALL S0. FT.
GROUT
DRINKING FOUNTAIN
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
_$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(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
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vac
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/ac
HOUSE SEWER
INSULATIONISOUND
GAS PIPING
PERMIT FEE
FINISH GRADING
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
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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS.
GARDEN WALL FINAL
IIIlillllllllllllllllllll 1$ bt 4� �
IE
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 70 1114 IA 0*lrrvsrLA QUINTA, CALIFORNIA 92253
Owner
Mailing SlIUBUILDING: TYPE CONST._
Address 755-405 11".187 C!I33t Drive
City lZip ITel.
Contractor
Address "
state LIC. LIty
& Classif. Lic. #
9st�21 Ufa 329t
-Arch., Engr.,
Designer
Address Tel.
City Zip 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 "" k- AJ ^ . - DATE
L U/OWNER:BUILDER DECLARATION
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
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
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.)
O 1 am exempt under Sec..B. 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. 3800, 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 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 youshould 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, Civil Code.)
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.
I .
Signature of applicant 1 Date s/ /
Number
No. 002568
OCC. GRP
Legal Description
Project. Description PM TEM RIAS3? 3 C
REMARKS y
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 INSPECTOR
Issued by: DatePermit
Validated by:
Mailing Address }' Validation:
City, State, Zip r
A631L
_.r HARD COPY
T
9 10 .566502 CK
Sq. Ft. 3478
Size - GM 696
No. No. Dw.
Stories Units
New ❑x Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
.Plan Chk. Dep.
Plan Chk. Bal.
593."
Const.
MOch.
R
Electrical
140.73
Plumbing
44.5j
S.M.I.
14.83.
Grading
Driveway Enc.
Infrastructure
2,000.00
TOTAL
3.665.,02
REMARKS y
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 INSPECTOR
Issued by: DatePermit
Validated by:
Mailing Address }' Validation:
City, State, Zip r
A631L
_.r HARD COPY
T
9 10 .566502 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
-GAR. SO. FT, @
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. 40
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SQ. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/ac
HOUSE SEWER
LATHING
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
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.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
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