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0208-123 (RR)Building 38 Arnold Palmer M N ON U °) Z Ia- O W LL UV L0 °) v Z ao 5 1` O LICENSED CONTRACTOR DECLARATION 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 1/31/03 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 PERMIT02N-123 DATE VALUATION $17,225.00 LOT TRACT JOB SITE ADDRESS BLDG. 38 ARNOLD PALMER APN OWNER CONTRACTOR / DESIGNER / EN (NEER PGA WEST RESIDENTIAL HOMEOWNER'S kg WESTERN PACIFIC ROOFING PO BOX 1060 3462 LA CAA/IPANA WAY LAQUTATfA CA 92253 PALM SPRI14GS CA 92262 (760)416-5877 CBL4 4293 USE OF PERMIT IIIIIIIIII I III IIIIIIII 56 IE H DO.38; 79.714,79-722,79-730: RE -ROOF WITH - - - POLYURETHANE FOAM &AC;RYLIC COATING ROOFING SYSTEM VALUATION 17,225.00 LS ESTIMATED COST OF CONSTRUCTION 17,225.00 PERMIT FET SU 414ARY REROOF FEE 101-000-418-000 530,00 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $30.00 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DTTE NOW $30.00 RECEIPT DATE BY DATE FINALED INSPECTOR : :] DAVE STEAVENS Inspection Services PROJECT �J'A LJE S+ L F.0 E g Z 5 ADDRESS 17 + / is BLDG. PERMIT # ENGINEER u ad SA Jv-lt /N+G INSPECTION TYPE Page —L of / 1111111111111111111111111 57 IE PROJECT # o7 w a .2 - O 9 CLIENT 2G A `t�a,„)m�E S7r Nuri DATE / I .7ar ru .J ,J 0 Z ARCHITECT 6o4.419 dXCO CONTRACTOR -)NCL MA\ sL PAC % i- s S. INSPECTION REPORT 9- &,#z-, &9v. L48 70G f/leyiZ J Apt l ►z C. or., ;W /7 Ptd A/ S"- 4. �/ 715 • - s NLA2 Mo 14t,✓G d1,01:g ' AJD A -Y r.JAraoy(. 16-T AJ t S - �, �• y pili, S'; 7, r y ls.. / -% Y ,r?Arsc /z , 17Nre'* X f%if..`/ �- --#M /GR f AJ4h — ,, 4L E rA W- lie.'722 73o dleAla". A-1iJ /S- U-1 slU-1 A t t..3 </i - 7 • JL 0<4lf44, n • 35 s, - Co.." OIL r r e �1 "i01L.A-7.1�Lvc.ke)A.1G e,2 -44r�t.c`�'c: *he Tik + LS - *A. 5' "% Js • 7' - ,giac� ,✓G A•. '� s Z 7y �s .sy5 Sc ows � i�a••�u r� x,11-5 " l'7�S ''7 " 81 VC W 0dC, St✓e:-4Z NAt ►%I re- AT- w E sr A rri c A)ap s Bt vc e!r T' Ak L)K r,r' i �t % A I, L f % 5 • '1 M 4. - lv S 6 c- C �r % `. 3 CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, substantially comp ies with approved plans, specifications and applicable sections of the building codes. This report covers tions or th* work inspected only and does not constitute engineering opinion or project control. CERT. NO. �C, ��� 3 41W - S 40 INSPECTOR NAME �A d'6 ST't A DATE ' INSPECTOR SIGNATURE 1`i••c.a.. ✓ DAVESTEAVENS Inspection Services PROJEt4 I:�&% W e'S*T- i C&G 00 5 ADDRESS !i Q• `71 7 a '7 3 V Page I of IIIIIIIIIIIIIIIIIIIIIIIII IE 58 PROJECT # o204a r C$A A EST HON CLIENT DATE 2 .'" ^a C q o o 'Z.. BLDG. -PERMIT # ARCHITECT GU 4. d A Arc.N ENGINEER; u 'SAJv rg # JG CONTRACTOR,bZU /NA 2 INSPECTION TYPE INSPECTION REPORT �� �l LS � � r � �S• �% ~ �j6►�'G li �� D �`y �/�f 4 1.�1G �„j�w�► /�l L.{1"= - 4A.S' q 0^ Jc. L` r (PIS -1- S GAR A/A 1 L W 6, PA j7T q ujA s.l.. 4./,o p q AM / 4 t :l} L a?i. C r k.47 1 CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, �substantially • les with approved plans, specifications and applicable sections of the building codes. This report covers k tc wort nspected only and does not constitute engineering opinion or project control. CERT. NO. (f W5 -V-? 00'J6 ` .3 © INSPECTOR NAME _ P► lI G"' ��f iltrh�s DATE 49 zrGx ^✓C: epao I. INSPECTOR SIGNATURE) • T .v+ 11111111 Jill 59 1` IE Building Address � 4 AyT^ Owner 4 P.O. BOX 1504 No- 002566 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 7r.005CbUrItXV iVa City Zip Tel. Palm mant 1 9.2260 - 568-2928 Contractor Address BUILDING: TYPE CONST. OCC: GRP. A.P..Number . Legal Description Project Description PIA VMW PfMM 3 C Plan 300 MR Sam City .. _ i Zip .. - Tel.' 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: State Lic. & Classif. 2881.30 City Lic. # 328Sq. Ft. VZ 3971 Size CiM• 657 No. No. Dw. Stories Units Arch., Engr., _ Designer New LK Add ❑ Alter ❑, Repair ❑ Demolition ❑ Address Tel. hereby affirm that there is a construction lending agency forthe performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) 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.' FINAL DATE ' This is a building permit when properly filled out, signed and validated, and is subject to SIGNATURE DATE y OWNER -BUILDER DECLARATION - I herebyl ffirm�that I am exempt from the Contractor's License Law for the following . reason: (Sec. 7034'. 5, Business and Professions Code: Any city; or county which requires a 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. "" _ subjects the applicant to a civil penalty of not more than five hundred dollars ($500). . ❑ I, as owner of the property,'or-my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec: 7044, .Buisness and - Professions Code: The Contractor's License Law does not apply to.an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements_ are not intended or offered for sale. If, .however, the -building+u orimprovement is sold within one year of completion,. the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) - ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- • struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law • does not apply to an owner of property who builds or improves thereon, and who contracts for • such projects with a contractor(s) licensedpursuantto the Contractor's License Law.) ❑ I am exempt under Sec. B. & P.C. for this reason Estimated Valuation A A. U I�dAn AliA PERMIT, AMOUNT - Plan Chk. Dep.. - - Plan Chk. Bal. - "7.190 COr1St. +>• R10{� Mech. mentioned property for inspection purposes. ,.1 Electrical " - . 14 Plumbing 14$.50 S.M.I. .. . 17.54 Grading Driveway Enc. Date owner Infrastructure 2,000.00 4 10 5855,48 U - HARD COPY WORKERS' COMPENSATION DECLARATION ' I hereby affirm that I have a certificate of consent to self -insure, br'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.) 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. TOTAL 3.P155.4.9 REMARKS - - 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 hereby affirm that there is a construction lending agency forthe 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 that I have - � � Permit certify read this application and state lhat.the above information' Is correct. Issued by( Date I agree to comply with all city and county ordinances and state laws relating. to building . construction, and hereby authorize representatives sof this city to enter the above- mentioned property for inspection purposes. ,.1 Validated by: ' Signature of applicant x+ '� trj ,- Date �l t Mailing Address ` r Validation: City, State, Zip / J ,! A631% 4 10 5855,48 U - HARD COPY CONSTRUCTION ESTIMATE NO. ELECTRICAL EESiak NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SQ. FT. POR. SO. FT. ® GAR. SO. FT. ® CARR � SQ. 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.COOL 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. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/4c 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 R AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK tROCKSTORAGE FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK 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