PLBG (9907-218) + BLCK (9542) + ELEC (9554)53520 Avenida Madero
9907-218
9542
9554
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
D 6 4 Signature of Contractor A l 1 C;'
OWNER -BU ILDER'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 isnot intended or -offered for
sale (Seca 7044, Business & Professionals Code):
( ') I, as owner of the property, am exclusively contractingwith licensed
contractors to construct the project (Seca 7044, Business & Professionals
Code). '
O I am exempt under Section B&P.C. for th.is'reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm' under penalty. of perjury, one of .the following declarations:
O 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:`
Y•
i"jI' + i1' Ii Z'- O&7b ,1"'ti.' 711M.";it3
(This -section need not be completed if the permit valuation is for $100,00. orless).
( )'I certify that in the performance of the work for which this permit is issu1.ed;
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 wit those provision v '
Date' Applicant'-_' '
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employerto criminal penalties and civil fines.up fo $100,000;:in
addition to the cost of compensation; damages as: provided for, in Section 3706
of the'Labor Code, interest. and:attorne'y's fees.
IMPORTANT' Application ishereby 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 unde'rOr pursuaht•tq
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 isnot commenced- within 180'days from date of issuance.,of such
permit,•or cessation of work for 180 days will subject permii to cancellation.
I certify that I have read this'applicatiori and state that the above information is
correct. I agree to comply with all City, ,and State laws relating to thebuilding
construction, and hereby authorize representatives of this City to enter,upoh
the above-mentioned property for inspection purposes."
Sig u e+ (Owner/Agent) Date
Is
BUILDING PERMIT PERM
i
DATE 071,1391%VALUATION • •. LOTS TRACT
JOB SITE
ADDRESS .2O.f@,'' .B ;NI .AEA.IM8. .93I RO.
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
j
PREFERRED a 1, IJINI M G
PO CONK 15 11
451.1 S '; I t' I)iN:l~•S:,PC
LA QUNCry, CA. ?92253
:>E'AM g 8r' SPRII I1.. :...: Cr 0-2164 . .
q
29
;
USE OF PERMIT
aW'r:ff .ABAXDOON SEVER. t;t; yrfl .;c 1'
' t'11C:6.ATI. fel - ., .' AO 4V J,'fA'LS,
Y
k'Lt..(ttlSHN-0 FEE.— sEWF.tiR 101-ftfli,419=000' 1i3€➢. +0
L di.)N J#
903 -:AX CI.03b AND iI1,C13ECK
i LESS P -PI: 4.'f`1lb FE. W
• . is
•"> .. ':^'.."
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
0
INSPECTION RECORD
• OPERATION
DATE
INSPECTOR
OPERATION
DATE
I 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 Wail 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 I
I
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
7- / _ e
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) 7—/& _
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 Notice (Perm)
7d 7- —eZ —7--VXF7
q..
t
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
7 632
Received From:. 2From:.—Date:
Address-.1Ij.; 17"11 t T
:1 Account No. Lots) 1w. Tract
Service Address G.A. Code
Eh 0 Meter(s).
0 Service(s)
0 Backflow(s)
0 House Lateral(s)
0 Detector Check(s)
0 Meter Surcharge
_7
DAanit.tion Capacity Charge
0 W.S.b.F.C."
0 Temporary Construction Meter
_w
.0 Turn on Charge
0 Uncollected Account - Name
'0 'Inspection Fee Tract - cu
Alh
Fee
Se -er'.
0 Plan Check Fees Water I w
8
Tract -
C1 Bond Payment - A.D. - Bond
Assmt.
0 Customer Deposit
0 Other
TOTAL
Remarks.
PuAlt i-. B -Mr -k OAS
WKY to:
WateF
Cash Service
Check
Money Cashier- •_:A ,
< D -4w (11189)
Order
Building
Address 53-52,0 deco
Owner
Je f 117 & _ Rollie Radri
Mailing
Address gc"!me
City Zip
La Quinta. 92253
Contractor
Matthews
h F
asotiary
Address
P.O. 60X'1504 No. 9554
78-105.CALLE ESTADO
*-r"LA QUINTA, CALIFORNIA 92253
e2
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Tel.
564-314 Legal Description
'` ,;;`• '. Project Description
Iiec : & each mor boax'o nd spa
P. 0. BOX. 751
City
Zip
Tel.:
Rancho min a4
92270.
779-8025
State Lic.
City
& Classif. '•C29 Q2.2.148
Lic. # 17e86 -
Sq. Ft.
i No.. No. Dw. '
Size
Stories. Units
Arch., Engr:,
Designer
New ❑ Add O • Alter ❑ Repair O Demolition -0
-Address _
Tel.
NOTE o NIC
for lights -to to he nska-I1h3d' in
City
Zip
State
y
Lic: #
..C3Cwall
LICENSED CONTRACTOR'S DECLARATION M. '
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
r "
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
` I hereby affirm that I am exempt, from the Contractor's License Law for the following
Estimated Valuation T"
] ' ' QQ
*reason: (Sec.'7031.5,Business and Professions Code: Any city or county which requiras.a
'
• permit,to •construct,alter, improve, demolish, or repair any structure, prior to its issuance also
w
h,requires the applicant for such permit to rile 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. o/ the Business and' Professions Code, or that. he is ' eicempt 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 o/ not more than five hundred dollars.($500)..
Plan Chk. Bal. ;
❑ :1, as owner of, the property,'or my"employees with wages as their sole compensation, will
;. do the work, and the structure is not intended or.offered for sale.'(Sec.'7044,•Buisness and `
9
i.,, Q0 'i'
..: a'Professions Code: The Contractor's License Law' does -not. apply to an .owner of property who
Const.
.
p6nds-or_.improves thereon and who does, such work himself or .through, his own employees, .
Mech. -
5-, v( -
provided that' such improvements are not intended or offered for sale. d, however, the building
,v;or::Improvement is•sold within one year of completion,* the owner -builder wID have the burden-'
Electrical
.' r. _
- SIJ
z ol.p ving that he'did not build or Improve /or the purpose of sale.)
.
,$.Y -:
r as owner of the property, am exclusively contracting with licensed.:contractors to -con- -
Plumbing ..
-.•
sfruct the project.'(Sec. 7044, Business and Professions Code: The Contractors License Law.
F does not apply to an .owner. of property: who builds or Improves thereon, and who contracts -for
.
• - ' such projects with acontractor(s) licensed pursuant to the Contractor's License Law.)
Grading
,
{
❑ -I am exempt under Sec. • B. & P.C.-for this reason
'
Driveway Enc.
Date Owner g +'' =-+ f" i at, k` i
Y Y q
Infrastructure
1
DECLARATION
WORKERS' COMPENSATION ^
• 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.)
' -
PolicyNo: Com any6
Copy is filed with the city. O Certified copy is hereby furnished:
-'
e
- 0 -'1 ._ 1 1J 9_ 05,7 I•- " %T r. l
TOTAL
?` i 5 1 t 1 Lf f t-tte L
CERTIFICATE OF EXEMPTION FROM
REMARKS
1 '--"t
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,'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 Exemptionyoushould,-become -
`the
ZONE:
'BY: '•'
subject to Workers' Compensation provisions, of the Labor code, you must forthwithMinirrium
comply with such provisions or this permit Shall be deemed revoked. -
- _
Setback'Di '
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 h this permit is issued. (Sec. 3097, Civl6Code:) . _ r r
whic
Side Setback.from Property Line '
Lender's Name
Lender's Address
•This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
' INSPECTOR
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..
Issued by: -
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.
Validated by:
Signature of applicant Date
' Mailing Address
Validation:
City, State, Zip
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. I SQ. FT.
WALL SQ. FT. ®
gQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOB]LEHOME 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3Ac
HOUSE SEWER
FRAMING
FINAL INSP.
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 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
� �
� A. �r �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION x/ -
v c
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Building 53-520 Madero
Address
Owner
Jeff Rodriguez
Mailing
Address same.
CitZip Qu iiita
a 92253
Contractor
Mathhews Masonry
Address
P. O. BOX 751
City Zip
Rancho Mirage 32273
State Lic.
& Classif. C29 4.22148
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
I.
564-3148
Tel.:
7'79-8625
Lic. #
Arch., Engr:,
Designer
Address Tel.
City IZip I State
Lic. #
LICENSED CONTRACTOR'S
I helby affirm that I am licensed under provisions
1786
full force
,,,,, 9.0
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 requiresa
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 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 rive 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 or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose or 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
1 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.)
Po'cy No. Company
opy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed it 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 Cer0cate 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. 9542
BUILDING: TYPE CONST.. OCC: GRP.-
A.R. Number
Legal Description
Project Description
5' .block wall
Sq. Ft. 240
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Block wall
can only be 5' high if pool
permit is
pulled; otherwise wall can
only be 4'
high.
Estimated Valuation
5 y 196.0 . 0
PERMIT.
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
81.00
Mech.
Electrical
Plumbing
S.M.I.
.60
Grading
Driveway Enc.
Infrastructure
ri`erna t%Atat-f 3i1a 14
TOTAL
R' i3 ` 17 '"""•
REMARKS
i
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. ® $
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
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.Fr.GAR ® Yac
HOUSE SEWER
FRAMING
FINAL INSP.
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 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
FINAL INSP.
ROOFING
�j
A
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