PAT (9601-102) + SFD (14017)78810 Lowe Dr
9601-102
14017
LICENSED CONTRACTOR DECLARATION
I Hereby afillm that I am licensed under provisions of Chapter 9 (commencing with
r Cn
W Section 7000) of Division 3 of the Business and Professionals Code, and my
C:)Cy co License is in full force and effect.
Cl u.):i *Glaskt3' t,' Z 12i31i0C
r w ^ License # U s xp. Date
K r, . Date r ` t 1 Signatureof Contractor
d)Z `r—c
0 0) OWNER -BUILDER DECLARATION
J W I hereby affirm that I am exempt from the Contractor's License Law for the
4 following reason:
(A ( ) I, as owner of the property, or my employees with wages as their sole
Z 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
N
O) rn WORKER'S COMPENSATION DECLARATION
d Q I hereby affirm under penalty of perjury one of the following declarations:
Z () I have and will maintain a certificate of consent to self -insure for workers'
<Ir compensation, as provided for by Section 3700 of the Labor Code, for the
X w LL performance of the work for which this permit is issued.
O J J ( ) I have and will maintain workers' compensation insurance, as required by
m Q U Section 3700 of the Labor Code, for the performance of the work for which this
OU permit is issued. My workers' compensation insurance carrier & policy no. are:
a: LO Carrier Policy No.
Z (This section`need not a completed if the permit valuation'is' or'$100.00 or less).
r- O () 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,-ptovisions j
`Date: Applicant If rG-t
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
V4
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
• above-mentioned property for inspection purposes.
Signature (Owner/Ager$) r % -t • ; o'.: PV p Date t `)
ALCM
BUILDING
PERMIT
PERMITS
Mn•.1+ut
DATE
VALUATION 314, 81 4?
LOT
TRACT
JOB SITE ADDRESS
APN
7f X 10 LOW E DR
OWNER
CONTRACTOR
At;)11A(-)I II -Sl' Ih )
K1,S
r
Niiw' MIX X I.,k;f,l i{ 4
W
{ (1,.11^ 1A11D!, 1 ul.
SAME
PA LNI DE:SEM' -12251
LQ
InIU144's.*il71I ('ttl-i; I AI)
DESIGNERIENGINEER
Z42..1070
USE OF PERMITor lir I
I.) LP hQi111) WAI,1. - IN 9'11, AND '41A
FEE DESCRIPTION
FEES
14.n.A, JkNDn.* SPA 14._*M)_1nI t.S
+ I•'1` WAf 1. 13 IN$ LM
o riNUTED COSI OF CONS I WI Irl;ON
14,781.45
0,;ItMI'll IF'FE SUMMAkY
111,AN 0WCK I•'FY. 1014W-4.10 SIS SIGS to
h!E 'lf iNl+`AL. FSE- tx' f, 101 100011?1_000S "I w)
LLEF:i RIL.'r11.141.* • PtA,)L 101-OW-420-WU V s IM)
PLOMBI FV -P .-- 0 , 4. 1014K)IJ-414-000 V11701
(!oN.TrR1!VTIr )N FRF 1014MA IR -WO Rth^ ftlS
tiLn3- 1 E, t:'t}Nti"1'Rt*t "1lt:if i AND PLAN ('HECK
S3(s3. 30
aLESS PRE PAID FEES
`
$0 ()i
D TOTAL PERMIT !r FES DUF NOW
-SU3.38
JAN 2 4:1996
r6y
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain Ur ly—Z
Bond Beam 17
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
061
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Nil
o I
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I 4 t
I I
MY OF LA OUNTA,
IFE N T
M IT I ON A L LY 41
ACCV-; RA,
jo,
SUBJECT TO. INSTALLAMON AS PER
In,
J, ALL DPLICA13LE Q DE
DATE Q
T a 0
-ityl 4 4 a"
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78-810 Lowe Drive LA QUINTA, CALIFORNIA 92253
Owner
Mailin
Address 8141 E. Raiser Blvd. #310
CityTel.
T
ip
Anaheim 92808 714-282-5884
Contractor
same
Ci
State Lic. City
& Classif. 293954 Lic. # 1612
Arch., Engr.,
Designer DC. Design
AdW-2351 Irvine Ave. R14-641- 1505
City Zip State
Santa Arta neigh s 92707 ILic.#
LICENSED CONTRACTOR'S DECLARATION
41 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
.2000) o ioision 3 of the Busines6'and Professions Code, and my license is in full force and
effect. 1tN — 4 C04
_SIGNATURE f `• DATE
OWNE -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, 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
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.)
D 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereb affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's mpensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy Company
opy 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 ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., If, after making this Certificate or Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 14017
BUILDING: TYPE CONST. VN OCC. GRP. P.3
A.P. Number 604-232-034
Legal Description Lot 163 Tract 23268 Phase 3
Project Description SFD Plan E
Acacia
Sq. Ft. No.
Size 235$ Stories
No. Dw.
Units
New x Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation $141,073.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
658.06
Const.
786.50
Mech.
55.54
Electrical
159.33
Plumbing
168.04
S.M.I.
14.11
Grading
20.00
Driveway Enc.
Infrastructure
3174.15
Arts in Public Places
1.02.68
TOTAL 5 138 s 33
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Cen eByne
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:
_ J
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
r
2ND FL. SO. FT. @
SLAB GRADE
YARD SPKLR SYSTEM
ROUGH PLUMB.
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT.
GAS (ROUGH)E 9
WALL SO. FT.
DRINKING FOUNTAIN
SO FT ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
TEMP. POLE
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
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
LUMBER GR.
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
SPARK ARRESTOR
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
df
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
CC
l
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)E 9
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) &�#qy
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP. / Zr 1
FRAMING /
FINAL INSP.
ROOFING �I
VENTILATION
C//,/��//'• / G(%' .
0
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LA ING
MESH
INSULATIONISOUND �r
FINISH GRADING
FINAL INSPECTIONzbf
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL