BLDG (0312-066) + RPL (15732) + SFD (05312)52293 Avenida Madero
0312-066
15732
05312
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. v
License # Lic. Class Exp. Date , A '
C•
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 &ndeAection B&P.C. for this reas n
Date / s ignature of Owner
WORKER'S COMPENSATION DE A f A? ION
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 is's'ued.
( ) 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.
(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 pgf Section 3700 of the Labor
Code, I shall fortwi.A comply with those.provi'' ol5s.
Date: L,Z+ Q pplicant t 1
N)
Warning:MailCir to secure Workers' Com pensation,,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 representa Ives of this City to enter upon
the above: mentioned property for in . 'cfon p0oses.
Signature (Owner/Agent) « r V Date // V
BUILDING PERMIT PERMITk l
DATE VALUATION S.2 LOT.. TRACT
9' d:
G
( /
JOB SITE
APN
ADDRESS 52-25 .fAWNIDA f"IMR, .0 r
.OWNER
CONTRACTOR / DESIGNER / EN (NEER
RAY MAR1114
O'Wi3.i?A - Bi litm,
S i 3t 'N .,s fl.'t'x fAY) R,U ..
°n•...
Lt. Cit. 92223
USE OF PERMIT
CHWEg AL BUILDING
100 LV V OARX)FEN A6'ALL, CITY ST.AaNL).A'RI)
6 ,FT, WALL
ESTmA K t) Corr or ci:►mlR%Tmon
Pvjmf r '.iy E g/ my xr
geit
CO1dST RUCTJOW FEE 101:<000-41€-000 WARD
SUB -=W, COXTS"i ' tTL""a..CiN AITD .17LAIR CJMCX
'iQ.i3(1
RECEIPT
DATE
BY
DATE FINA U
INSP
/r
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 8 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
Bole Beam p . d
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Not (Perm)
COMMENTS:
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder'' you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City_ or County. They are also required by law to put their license number on all permits for which they
apply_
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if. you do not carry out these obligations, and these risks are especially serious with:.
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact. the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own -employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Ouinta_JCA_M f ^
FAX:
'S SIGNATURE-kDATE
5c;2- ;Lq3' Q. k
PROPERTY ADDRESS
031.2-044,
PERMIT NUMBER(s)
P.O. BOX 1504 N o . 15732:',
Building '52 -293 Avenida Madero 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner , Alan ?.Cbe:3 1
Mailin BUILDING: TYPE CONST: OCC: GRP..' „ -'•
Address S"e AS above A.P. Number
City Zip Te1: t• ;'; ,
'i61 QL1a:iitc2SJ 564-1'632Legal Description
Contractor
owner,Builder
Address '
City. Zip
State Lic.-
& Classif. .
Project Description Pool Only
Tel.: ,
City - • • S s t
Lic. # Sq. Ft. No.. No. Dw. , r ,.
Size ; St
' Arch., Engr.,
ones Un Is
Designer
New'❑' > Add ❑ Alter ❑ -Repair ❑ - :Demolition ❑
Address
Tel.'
S7 ]3y •a3tt81CyieE _
-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:
'' _ •. t ''' ,
i 31GNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that l am exempt from the Contractor's License Law for the following
Estimated Valuation $91000.-00 . _ ' I • '
reason: (Sec. 703 1..5, Business and Professions, Code: Any,ctty or county which requires a
permit to construct, atter, Improve, demolish, or repair any structure, prior to Its issuance also
- - -
requires the applicant for such permit to 81e a signed statement that he is licensed pursuant to
-,,PERMIT,- - •• `
-
the provisions of the Contractor's License Law, Chapter 9 (commencing, with Section 7000) of
- , 1.
' Division 3 of the Business and Professs Code, or that. he is exempt therefrom,; and the basis
Professions
'l 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 rove hundred dollars ($500).
employees
Plan Chk. Bala 20
,❑ I, as owner of the property, or my with wages as their sole compensation, will -
do the work, and the structure is not Intended or offered for. sale. (Sec. 7044, Buisness and
LO,
-COr1St: rr .DS •. 0
-
Professions Code: The. Contractor's License Law does not apply to an owner -or property who
builds or improves'thereon and who does such work himself or through his own employees,
Mech.' r'' •. „ . s.SiV
- -
,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
Electrical -
of pro ving that he did not build or onprove for the purpose of sale.)
Q
pill, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing •.. $ 27'.00
strucl the project. (Sec. 7044; Business and -Professions Code: The Contractor's License Law
S. M.1. (•' -. •. < tri" ,::.• -
• does not apply to 'an owner of property, who. builds or improves thereon, and. who contracts.for
' such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading +
'
• _❑ I am exempt under Sec. - - B'& P.C. for this reason.
Driveway Enc.
' . teC.I 7.•
-4-Da_; r e
.f rr' ♦ ,rr r :.. t / t e ro<y'a t- /.• r. vs .± ,
_
Infrastructure •
-
dti
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a'certificate of consent to self -insure, or a'certificate of
Worker's Compensation Insurance, ora certified copy thereof. (Sec: 3800; Labor Code.)
Policy No. Company
i
Copy is with the city, ❑Certified copy is hereby furnished.
'
TOTAL 7 vi, 20
CERTIFICATE OF EXEMPTION FROM
REMARKS`' p +
-WORKERS' COMPENSATION INSURANCE
(This -section need not be completed 'lt the permit is for, one, hundred_ dollars . ($100) valuation
tt
D j ,_
or less.)
r I certify that in the performance,of,thp work for which this permit is issued, I shall not
1
employ,•any person in any manner eb a`slto become subject to the Workers' Compensation
Laws4of}Cell
% `f %3!
r €
-
Date of.Owner ! s'` r / %. 1. .l /i d Cr
NOTICE TO APPLICANT: ff aReiimaking this or Exemption's become
4
ZONE: °•
gertgocate you. should
subject to the Workeis' Compensatlon provisions of the . Labor Code; you- must forthwith
comply with such provisions or this permit shall be deemed revoked. -
- -' BY:
-Minimum Setback Distances: .
Front Setback from Center Line
Rear Setback from Rear Prop. Line -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND • •
Side Street Setback from Center Line '
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, .
Side Setback from Property -Line.
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND .•
- '
ATTORNEY'S FEES. • .. - ' • •:. ..
' Tlrisls a building perrtiit when properly filled out, signed and validated, and is subject. to
. - -' -
FINAL DATE ; • INSPECTOR
expiration. It work thereunder is suspended for 160 days.
1 certify,that'I have read this application and state that the above information is correct..
Issue d -by: LA". Date - 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.
,Signature
Validated by:
of applicant Date
Mailing Address '
Validation:
City, State„ Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES`
1ST FL_ SO. FT. ® $
2ND FL. SO. FT. ®
POR SO FT ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM l
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
ROUGH PLUMB.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FORMS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
DUCT WORK
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
TEMP. POLE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
WATER HEATER
SO.FT.GAR ® 3/.c
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN
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)
f
METER LOOP
HEATING (FINAL)
OTHER APPIEOUIP.
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
q
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
ri
s
phOL= 14 x2( ) S -a t ,p '
w
/ 1 9ADW,5 $m
V 2 H. P_ P1114P ( F/LT R.
-x, s rld 6 CEDAR FE'VC37
Poot E QUiFMENT ; RPS •(SDa , '
AIN
. o'f
5
WOOD GOAD ✓ -
• • • ov ' • 3,- ten.
(9 , ?
Q a POOL AREA TO BE E :CLOSED BY
MIN IMIUM 5 FT. H6% FENCE.
o ALL GATES TO BE S F—CLOSING
AND SELF—LATCH"I N
lB PLANTERS
❑
Bp b ;A
IN I
a
CV PON.
SUBJECT
TO jjlwTA .d. . .,
• _.oast . ... ,
ANU ALL APPLI-A-
DATE
EXISTING RD ME.
i, AUG -25-95 FRI 15:01 CITY OF LA GUINTA
,d
6197777011 P.01
4 1 . lr l,R'
LH A 1 iV'1' *►
contractor (yhl t /
Address
'ekh
Job Address
Owner
This form shall be pouted on the job with the Building Inspection Card at all tlmes ;
is the responsibility of the Ceneral Contractor or the Owner/SOL
Conspicuous place. It
to monitor the sub -contractors that are on
this list are the same persona performing
\, work. Any changes of this list must be approved by the City of La Quinta Departmen+
to work being performed by a changed sub -contractor. Failur
Building and Sagety prior
ca®ply will result in a stoppage of work and/or thea voidance of building yerwit.
A
TRADE 6UB-CONTRACTOR NAME
CLOINCTNSETNR,B onmO. NFILEP• CICENSSITY SNOEa
GRADE/ ,} i Cl 14:
,l
o 7
EXCAVATE
g97G
PIPELINES
/
CEMENT/
FOUNDATIONS
CEMENT/WALKS
& DRIVES
ASPHALT
FRAMING
(x ,(%11
)STEEL/.
/1/A;6 A q q %'0
TRUCTURAL '!_f"`,
MASONRY
ell
PLUMBING
LATHING
DRYWALL
LASTERING
HVAC
ECTRICAI. a
ROOFING
SHEET METAL
FLOORS
GLASS/
GLAZING
`INSULATION
SEWAGE DISP'
PAINTING/
DECORATING
TILE
CABINETS/
INSTALLATION
ORNAMENTAL
METAL
i ENCES/
'
BLOCK WALLS
LANDSCAPING
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 52-293 i OER0 LA QUINTA, CALIFORNIA 92253
Owner
DEMS RIM MERG
Address 77-600 D0- LAWARE
City Zip Tel.
PA7.1t DWER 92260 345-7307
MINUJBUILDER
State Lic. City
& Classif- 453778-R Lic. # all
Arch., Engr.,
Designer
Address
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
77000) of Division 3 of the Business and Professions Code, and my license is in full force and
ffect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,8usiness and Professions Code: Any city or county which requires a
Permit to conshuct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 Me appdcarmt [o a civil penalty of not more than five hundred dollars (5500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will
do the wodc, and the structure is not intended or offered for sale. (Sec. 7044, Busness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or 7nioroves thereon and who does such work himself or through his own employees,
provided that suchrnprovements are not intended or offered for sale. N however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he dkf not build or kirprove for the purpose of sale.)
❑ 1, 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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec y B. 8 P.C. for this reason
Date 7+ f f Owner c .t' f;#Ir+"T f:.t+i rA ` 6e?s'1.i.5f ram
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of
Workers 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.
i CERTIFICATE OF EXEMPTION FROM
f WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) vatuation
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 ( I'
Date Owner .J_w
N077CE TO APPLICANT If, after -making this Certificate of 64wm- tkin you should, become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
coney with such provisions or this permit shall be deemed revoked. i
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.)
Lenders Name
Lenders Address
This is abuilding 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 inspectton purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 45312
11LDING: TYPE CONST. OCC: GRP.;
P. Number 773-x241-020
Legal Description Li3T t l
Project Description S••3%•
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 2%3/89 Permit
Validated by:
Validation:
Sq. Ft. 1F7SS
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
96,207
PERMIT
AMOUNT
Plan Chk. Dep.
250.30
Plan Chk. Bal.
2G,0.17
Const.
626.00
Mech.
53.50
Electrical
119.35
Plumbing
157.5
S.M.I.
5.79
Grading
20.00
Driveway Enc.
.20.00
Infrastructure
2,126.40
TOTAL
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 2%3/89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT.
GAS (ROUGH)
WALL SO. FT.
HEATING (FINAL)
DRINKING FOUNTAIN,
SO FT ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE IFL.CK.FEET
NST. 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 SE
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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 - J '
FINAL INSP.
4 ROOFINGL
/ J ! —
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
ING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL
Building
Address
Owner
7:S1'
Mailing
Address
ractor
ress
4
P.O. BOX 1504 APPLICATION ONLY
7&105 CALLE ESTADO
a LA QUINTA, CALIFORNIA 92253
rn BUILDING: TYPE CONST.
17,9----',1—o
OCC. GRP.
t 0 R' (1/ A.P. Number / / r J/ —o 0
Zip Tel. 53
Q aa Legal Description '
Project Description
1
State Lic.
& Classif.
Arch., Engr.,
Designer
Lic. # -
Sq. Ft.
Size
New
No. No. Dw.
Stories Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
ZONE:
City
Zip
State
Lic. #
Front Setback from Center Line
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 DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Suslness 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 rile 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 thabhe 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 live 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, Bus ess and Professions Code: The Contractor's license Law
does not apply to an own of roperty who or Improves thereon, and who contracts for
such projects with a coptractor(s) licensed pursuant to Contracto ' Law.) -
rS/
❑ 1 am exempt u der Sec. B. & P.C. fo t i reason
Estimated Valuation
-
PERMIT _ - AMOUNT
"
Plan Chk. Dep. 5
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Dat ' owner -
Infrastructure
/WORKERS' C NSATION DECLARATION
I hereby affirm thatA'h a certificate of consent to self -insure, or a certificate of
Worker's Co1n6psatfo'n Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O 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 (5100) 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, alter 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 Ii
This is a building,permit when properly fit ed out, signed and v idated, and Is subject to
expiration if work thereunder is suspended f r 180 days.
I certify that Vhave read this applicatio and is ate that t bova information is correct.
I agree to codiiply with all city a my qrd' antes an state laws relating to building
constructiorf, and hereby autho re a a atives,.of • thl city to enter the above-.
mentioned/property for InsD n Duro
Signature of
.Mailing Adc
City, State,
FINANCE
TOTAL
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:
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
.
®TAC SCHOOL FACILITY FEES W
Q94RUCATEL),
1. St -"S DOC(J"VIENT CANNOT
TO: City of La Q94RU DATE:
Department of Community Development
78-105 Calle Estado
La Quint'a, CA 92253
This is to certify'that VL %
developer of w ch is
located at -,!-5;9 - , within
this District, has paid school facility 'fees imp sed pursuant to the
MWgen rat d b ovnmen Code ectio5 53 80 in the amoynt o
covering a total of square feet o (, ) residential or
( ) industrial/commercial development and that building permits for
this footage in this development may now be issued by your jurisdiction.
012) for DESERT SAbhbS UNIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
OF R
{ OFFICE OF E. LEON SPAUGY
Q? COI.45i10'.FA , ; s AGRICULTURAL CO,.MMISSIONER
^,I JAMES 0 WALLACE
O d AND ASS;S,A.%f COMMISSIONER
CLEMENT BENVE` ISTE
WEIGHTS Ec MEASURES
SEALER
49413 nWy 86, Suite B-12
`',.,;.,.,• ' Coachella, CA 92235
MgYv a9 619-342=8291
DATE % 2 Z '" . 7f CASE NO.
DEVELOPER'S NAME,
ADDRESS- 7 % — 6 00' :
toe Gq 9 221 D
TELEPIIONE: 3 Yr- 73 0 7
Z
Dear Developer.-
After
eveloper:After reviewing your landscaping plans, all plant material listed is not in
violation of quarantine laws governing the Coachella Valley. If substitutions
do occur and they differ fran plant material listed, this office 'must be notified
iinr>ediately.
Thank you for protecting and preserving the Coachella Valley's pest -free environment.
Agricultural Courniss o uer's Office
cc: Indio and Riverside Office
' a
Buena Engineers, Inc.
---'79-811 Country Club Drive, Suite 4-- -
Bermuda Dunes, CA 92201 • (619) 345-1588 / 328-9131
h
Client Name
Client Address
Client Phone
DATE
'' / 30
_. _.
TEST LOCATION
T
JOB NO.
PROJECT
5a -arl3 N / A
✓riac'f Ra of I
LOCATION//
MOISTURE
CONTENT
%
CONTRACTOR
MAXIMUM
DRY
DENSITY.
%
OWNER
WE/A THER
(I If
TEMP. oat AM
0 a PM
PRESENT AT SITE
TEST
NUMBER
_. _.
TEST LOCATION
T
LOT
NO..
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
IbsJCu. ft.
MAXIMUM
DRY
DENSITY.
%
MAXIMUM
DRY
DENSITY
Ibsla. ft.
OPTIMUM
MOISTURE
CONTENT
%
It<= 6
//,
/07.
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52-z9 /or 11
5
73
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REMARKS: Do a.
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/
FIELD REI'®RT
3979 CLIENT REPRESENTATIVE SIGNATURE TECHNICIANS SIGNATURE
Buena Engineers, Inc.
--- "79-811 Country Club Drive, Suite -4- - - - --
Bermuda
Bermuda Dunes, CA 92201 - (619) 345-1588 / 328-9131
Client Name
Client Address
Client Phone
DATE
3c
TEST LOCATION
14 0 / j A
T
JOB NO..
,PROJECT
5a - 2 3
LOCATION
MOISTURE
CONTENT
%
CONTRACTOR
rjl✓lS
MAXIMUM
DRY
DENSITY
OWNER
WEATHER
01s/1 - I I
TEMP. oat AM
10 a PM
PRESENT AT SITE
TEST
NUMBER
TEST LOCATION
14 0 / j A
T
LOT
NO.
ELEVATION
FIELD TESTING
REFERENCE CURVE
MOISTURE
CONTENT
%
DRY
DENSITY
IbsJCu. ft.
MAXIMUM
DRY
DENSITY
MAXIMUM
DRY
DENSITY
Ibslcu.ft.
OPTIMUM
MOISTURE
CONTENT
a o
cG
SZit
73
M
Ca)
AVfNI.),-^r /,V)Ryfgo
REMARKS:TGo -7-cf75 4r : J 1 v
Q7111
d x 2 6LM5. n/1
46) —717-1 /)1( -{T 7s.
FIELD REPORT
3 9 7 9
CLIENT REPRESENTATIVE SIGNATURE TECHNICIANS SIGNATURE.