RPL (9704-080) + SFD (14913)78755 Lowe Dr
9704-080
14913
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
57,1127 A K13E191
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 Policy No.
a"rA11i 1'11tVi.i 1 Jf7fi'; 4-i.l
(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
ubject 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 Joid 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
t e above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION • LOT 97104-0X0 TRACT 5005
I, 5- 9 ,
JOB SITE APN
ADDRESS 78-755 1A)WE DRIVE
OWNER CONTRACTOR/DESIGNER/ENGINEER
DKO7 I I'll," WMAt'1 S "VE DODSON CON-KIRUt'"1' ON
18755 LU is Ok 73.011 COUNTRY RY s:..i.UB 1.1it1VE. ErE F4
LA Q1.11N'IA (!A 922.53 PALM 10SEIRT CA 0220
17601' 46.1032 131,M Milt
USE OF PERMIT
T'tKA,
114-a_rl, ANO NVA ON1, s
V AILIJAI'Tt..JN
ta,rii0,(* L.,
i auY■ {gg) {{ y i(7y j i I+;: '1.'t :IA TED CONT01? C't: NY!"RUC."' 'ION'
kV
PLAN <'}I1 t IC 0A- i 101.000-4-19-319 8015 Y
f"f
Tr1,I( q4 144., 101.11(tifa-A 19.000 11(1200
N:irC.'1IANICM, FEE -- I)tKA. 101-000-121-000 Swf.t?tt
Isf.lsCTR ICA 1.1,Vli,-• f4.0.:r1. $45.4t)
Vl.1.INJO1NO 1444 -- 101-00114404} SX' (01
14,600.00
4
4.
TI;-'T't )'l'hI C'0NS-MJ K -110N ANT) PLAN (111-01Z s 1 V1
LESS NW-PA41) FEI'3 $0 00
1997
I AL QUIN"
DATE
I'M At, PFRUIT F rY.44 11)1 IF, Tti01V
BY I DATE FINALED
INSPECTOR
$at► -1.317
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 APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam ,
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
/
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
3K
I
5'o I ff pi
EQ WALL BY S.D.C.
F250
O■
I'
25
+2I2'
R3' -6
cnn i9 7'1
r -
r
GAS
17'
el ' BOB CAT
TE
Y OF LA' A
BUILDING
.1 , I, I Nn ._,.T. i i i- 9 T
C 0 PJ`� f'Tl ON ASL LY
NCCEFTL� FOR CONST' ��' 1{0
SUBJECT70 AS PER
/I
ALL
VA
GENERAL SPECIFICATIONS
SIZE 15 x 28
%REA 257 PERIMETER 73
)EPTH 3'6"x5'
-ILE CHOICE T•B•S SO. 60
RBB. +6"/ 34'
TOPING cant
PUMP CAPACITY
GPM
MOTOR HP STA RITE
HP 1
MOTOR HP
HP
FILTER STA RITE 300
SQ FT
FILTER RATE 103
GPM
HEATER LAARS SIZE 250 BTU
TURNOVER
HRS
SUCTION LINES
2 "
r
GAS
17'
el ' BOB CAT
TE
Y OF LA' A
BUILDING
.1 , I, I Nn ._,.T. i i i- 9 T
C 0 PJ`� f'Tl ON ASL LY
NCCEFTL� FOR CONST' ��' 1{0
SUBJECT70 AS PER
/I
ALL
VA
GENERAL SPECIFICATIONS
SIZE 15 x 28
%REA 257 PERIMETER 73
)EPTH 3'6"x5'
-ILE CHOICE T•B•S SO. 60
RBB. +6"/ 34'
TOPING cant
PUMP CAPACITY
GPM
MOTOR HP STA RITE
HP 1
MOTOR HP
HP
FILTER STA RITE 300
SQ FT
FILTER RATE 103
GPM
HEATER LAARS SIZE 250 BTU
TURNOVER
HRS
SUCTION LINES
2 "
RETURN LINES 2-1.5
SKIMMER MODEL AM
CHECK VALVE YES
GASLINE BY S.D.C. FT.
POOL LIGHT 400 CLOCK
ELECTRICAL BY. S.D.C. r_
PLASTER COLOR white
DECK BY S.D.C. SQ. 681
STEP 9 FT.
SPA SPECS.
SIZE 7 RAISED +12"
LITE 1 WATTS 100
RI LEVEL SEATS 22" 24" 27"
DAMWALL ' °i X 1
DESIGNER DAMWALL TOP tile
SPILLWAY SIZE '"X " " WIDE
jamie SPILLWAY X OPEN CLOSED
DATE # JETS 4 UPER LOWER
3/4/97
Name: DON NEWMAN
Address: 78755 LOWE DR
city: LQ
TRACT LOT#
® son
Poo/w
USTER COPYPALM DESERT TEMECULA
73-011 COUNTRY 28910 RANCHO
Scale: 1/8"=1'0" CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. STE 206
NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA.
ARE SHOWN FOR ILLUSTRATION (619) 346-4032 90
ONLY AND ARE NOT INCLUDED. I Ir -U A-C7A 1 (9900 9)676 -SWIM
r
4
P.O. BOX 1504 No. 14913
Building
Address 78-755 LOWe Dr. LA QUINTA, CALIFORNIA 92253
Owner ACaCia Construction
BUILDING" TYPE CONST OCC GRP
Mailin
Address 8141`.,E. Kaiser Blvd. -#310 A.R. Number €(34-233--a01
City zip
T
naheim, CA 92808 (714;282-5800 Legal Description Taft 170 Tract 2.32613
Contractor Project Description $FD Plan C
Same
Address
- City lZip 11
State Lic. g_1 293954(City 1612
& Classif. Lic. #
Ivrcn.; tngr., DC Design
Designer
11 Ir V Irvine Ave. T014 ) 541-1505
anta Ana Heic i CA 92 L }#
LICENSED CONTRACTOR'S DECLARATION
I hereboff that I am licensed under provisions of Chapter 9 (commencing with Section
7000) lot iv sion of the Business and Professions Code, and my license is in full force and
1k DATE
OWNER -BUIL ER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bust7ess 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 or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
0 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
1 of proving that he did not build or fnprove for the purpose or sale.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business andProfessions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projectswith 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
WoRz
Ce, or a certified copy thereof. (Sec. 3800, Labor Code.)
Polmpany
O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff 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 pparson in any manner so as to become subject to the Workers' Compensation
Laws of Caltf0 nla.
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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($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. `
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, Zlp
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft.
Size 3591
No. No. Dw.
Stories Units
New ❑ Add ❑ .
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR~ -
I
Permit
Issued by:
Estimated Valuation-
$98r445.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
535.78
Const.
635.00
Mech.
55.50
Electrical
131.49
Plumbing
144.00
S.M.I.
3.84
Grading
20 . 00
Driveway Enc.
00
Infrastructure
2,215.02
TOTAL
3,747.63
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~ -
I
Permit
Issued by:
Date
/
Validated.by:
Validation:-
• f ✓
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
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
B DE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH) 6
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/e c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® V4c
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 4 ` 000 ELECTRICAL HEATING & AIR COND. SOLAR
ETBAC
GROUND PLUMBING
III
UNDERGROUND
A.C. UNIT
COLL. AREA
B DE
ROUGH PLUM
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) 6
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
LA G
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL