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BLDG (9604-104) + PAT (10276) + BLCK (04781)53625 Avenida Madero 9604-104 10276 04781 f . LICENSED'CONTRACTOR DECLARATION I hereby affirm under penalty of perfury`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 ?+ iit) t5 ty.t 55IN6. Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm tinderpenalty 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). O 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. ( ) 1 -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"IsS80. MytQKdrs' compensation insurance carri1NW $Y1icy no: are; Carrier :. Policy No . (This section need not be completed if the permit valuation is for $106.60 or less)'. ( ,) I certify that in the performance of the work for which this permlt_is Issued, I shall not employ any person' in any manner so as to become subject fo"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 forthwithcomply with,tho e,.p rovlslons Date:. A(, L: Applicant 01 , Ztt r'` y Warning: Failure to secure Workers' Compensation coverage is unlaw brand shall subject an employer to criminal penalties and civil fines up to $1.00,000, 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 ''restrictioris 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-applicatonagrees 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..andvoid 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) (? r1 a Date . , PERMIT# .i. . CONTROL# BUILDING PERMIT - . 31.85 ' ' DATE 4/.22196 VALUATION y ( ' LOT' TRACT JOB SITE ADDRESS' 1 u:L :: 1 i l!. FAPN %rI -BQIIr gf " OWNER CONTRACTOR/DESIGNER/ENGINEER 111 trcp nrl.."'t"Rot4 DAVIS ROOFING 53,625 AVENIDA MADERO;' aa1. C:r5 CALl.lr PALMA 1A QUIN7C.A. C .A 022 JS LA QUINTA CA 92233 f Ci i tA iki" Si? 3 . fifi;l !fi( t 041"7 C-BIA '2409 . USE OF PERMIT f)OP kg R M F t i',E SUMMARY ' r' ;t~:.. :t)1•iftxf ifz.i ...3 00, C Cn 1 CQ. SuB- CC`l:tU, COAIML;CTION :.A;l D PLAN CHECK , F ;'-.' $330.00 ; LESS PRO' TAID FEES: 7VOTAL PERMIT FEES DUE -NOW'. RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms<r Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck L Exhaust Fans OX to Wrap I F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Piaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels. Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Page No. of Paqes DAVIS-ROOFING 51-075 `Calle Paloma L'a Quinta, CA 92253 (619) 564-0407' tai: #530086.. PROPOSAL SUB E TO PHONE DATE - 4 09 1 o STREET, JOB NAME S3.63 CITY, STATE and ZIP,CODE , JOB LOCATIONCAL rrll V / Vl • ARCHITECT . ' ATE OF PLANS f JOB PHONE EPropose hereby to furnish material and labor— mplete in accordance with c: fications below, for the sum of: ` 'i t W lollars ($ `VA8 Payment to be made as follows: . S. f , ). All material is guaranteed to be as specified. All work to be completed in a workmanlike, manner according to standard practices. Any alteration or deviation from specifications Authorized below involving extra costs will be executed only upon written orders and will become Signature an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary Note: This proposal may be insurance. withdrawn by.us if not accepted within days. We hereby submit specifications and estimates for: Vd I' i1Pi Q e;/ Iff" tgyc J UV Acceptance of ipropos l -The above prices, specifications and conditions are satisfactoryand are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature. \ Date of Acceptance: / ' / / Y Signature wBuilding • 53-^ 5 .` Scl i 'rti. Address -Owner William C. Herron* Mailing Address i 35 s Pinyon St City Zip Palm •fie: ert 92260 Contractor Owner/Builder Address City Izip I Tel.: P.O. BOX 1504 No. 1U276. . 78-105. CALLE ESTADO r ' - LA QUINTA CALIFORNIA 92253 .: BUILDING: TYPE CONST.'&' OCC: GRP.- A.P. Number 346--6565 Legal Description Project Description Patio cover and hat water heater State Lic. City & Classif.. Lic. # BArch., Engr., Designer Address ` ^ Tel .on Sq. Ft. 3f}► No No. Dw. Size _ Stories Units - LNew O' Add 0 Alter ❑ Repair ❑ Demolition ❑ ' 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 myticense is in full force and Q"}' effect... .. c{.... SIGNATURE - DATE " OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following . reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a i_ ' permit to construct, alter, 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 ' Divisloh 3 of the Business and Professions Code, or that. he is exempt therefrom, and li the. basis .for thealleged exemption. Any; violation :of.. Section ..7031:5 by zany applicant - for a permit - subjects the applicant to a civil penalty'of not more than five.hundred dollars (S500). . -Al, 4sowner . owneof the property, or my employees.with wages as their sole compensation, Will Estimated Valuation .3 y 9 U Q • - .• PERMIT - - AMOUNT ` •. Plan -Chk. Dep. • - - Plan Chk. Bal. Ya Const,.. . 63 00 the•work, and the structure is not intended or offered for (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. ff. however, the building or Improvement -is sold within one year of completion, the owner -builder• wig have the burden of proving that he did not build or improve for the purpose of sale.). . Mech.- - Electrical - Plumbing'L'. • D I, as owner of the property, am exclusively contracting with licensed contractors to coo- • struct the project. (Sec. 7044, Business and Professions Code: The Contractors 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.) - O 1 am exempt under Sec. B. & P.C. for this reason a S.M:I-.- ' ;_.' • •" . _ Grading r Driveway Enc. ;Date owner 1 d p• . _ Infrastructure , WORKERS' COMPENSATION DECLARATION I hereby affirm that I 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. Com an ❑.Copy is filed with the city. D Certified copy is hereby furnished: Lg - TOTAL 63. 40 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE' REMARKS` (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) .. .. I certlfy.that the performance of lhg'wor for which this permit is'issued, I shall not employ any pperson imany manner,_so s4tob ome Subject t ithe Workers' Compensation , Laws of Califor t / " t r t ' Data11 / !d loner s ' -it /i /(,r _ .; NOTICE //TO APPLICANT: II/taRer making this-Certilicate o/ Exemptam you s.'au become - subject to the Workers' Compensation provisions. of the' Labor Code, you musr- Iorthwith •;. co • •mply wtth such provisions or this perniitshall be deemed revoked: .- - ZONE: • BY: - Minimum Setback Distances: -•• , -' • Front Setback from Center Line Rear Setback from Rear Prop` Line •a CONSTRUCTION LENDING AGENCY - Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit'is issued. (Sec. 3097, civil code.). Side Street Setback from Center Line Side Setback from Property Line Lenders Name Lenders 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. FINAL DATE e' INSPECTOR 1. I certify that I have read this application and state that the above information is correct.ISSUed.by: 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. . 17 ' Date Permit' Validated by: Signature of applicant Date '. Mailing Address * , Validation: - City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL.' SQ. FT. ®' POR. SO. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SO. 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 APPJEQUIP. 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 ® 1 V4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER 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 & 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 FINAL INSP. / / GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING 4k/AL / FINAL INSP. / % ! ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL JiT, 4.4 f , tis" ,4`•', t r ex% - : • + : - P.O. BOX 1504 Build mg ,•yF 78-105 CALLE ESTADO } Address'."'•' LA QUINTA, CALIFORNIA 92253 Owner ' ; ' • .• ' rnMailing- r I Address -• >„ 1' City Z7c t• Contractor Tel. City , Lic. # Tel. State LIC. # CLARATION hapter 9 (commencing with Section Code and my license is in full force and DATE RATION ors License Law for the following Any city or county which requires a structure, prior to its issuance also ment that he is licensed pursuant to (commencing with Section 7000) o1 is exempt therefrom, and the basis 1.5 by 'any applicant for a permit dred dollars ($500). . es as their sole compensation, will for sale. (Sec. 7044, Buisness and apply to an owner of property who self or through his own employees, ed for sale. It, however, the building owner -builder will have the burden e.) g with licensed contractors to con - Code: The Contractor's License Law over thereon, and who contracts for; tractor's License Law.) reason ... . CLARATION I to self -insure, or a certificate of ereof. (Sec. 3800, Labor Code.) erebyfurnished. N FROM REMARKS SURANCE one hundred dollars ($100) valuation ch this permit is issued, I shall not fact to the Workers' Compensation of Exemption you should become • ZONE: BY` e Labor - Code, you must forthwith caked• Minimum Setback Distances: Front Set " Rear Setb GENCY. . ,_ Side Stre( agency for the pertormance'of•the e7 Side Setba ed and -validated, and is subject to FINAL DATE I the above information Is correct. r Issued by: ' and state laws relating to building.— this uilding -• this city to enter the above- „ F Validated by: Date }Validation: ` K ,,:APPLICANT,GREEN BUILDING, GOLDENROD - ASSESSORS OFF . ..e. '.'.'11 ....4w,r x_,i M1..1<: `. r. .r. _.. by .... -. ;,. ,. •.-'.5. -1 ... Address ''City Zip . .State Lic: & Classif. Arch., Engr., Designer , Address . Tf;s City _ Zip :,: , • ; LICENSED CONTRACTOR'S DE I hereby affirm that I am licensed under provisions of C 7000) of Division 3 of the Business and Professions Cod effect. 4 SIGNATURE C OWNER -BUILDER DECLA I hereby affirm that I am exempt from the Contract reasorci (Sec. 7031.5,Business and Professions Code: permit to construct,. atter, Improve, demolish, or repair any .requires .the applicant for such permit to rile a signed state the provisions of the Contractor's License Law, Chapter 9 Divlslon'3 or the .Business and Professions Code, or that. he for the, alleged:d exemption. Any violation or Section 703 subjects the applicant to a civil penalty of not more than rive hun 0 I; as owner of the property, or my employees with wag do'the work, and the structure is not intended or offered Professions Code: The Contractor's License Law does not builds T -or improves thereon and who does such work him provided, that such improvements are not intended or offer or: improvement is -+'•sold i within one year of completion, the - of proving,that he:did not build or improve for the purpose of sal 0.1,'4s owner•of the property, am exclusively contractin struct the project.. (Sec. 7044, Business and Professions i does not apply to an owner of property who builds or impr such projects with a contractor(s) licensed pursuant to the Con ❑ 1 am exempt under Sec. B. & P.C. for this Date << ! '% ' Owner • ''M, •f - - ' •' f y WORKERS' COMPENSATION DE I+hereby.affirm that I,have a certificate of consen Worker's Compensation Insurance, or a certified copy th Policy No.;• Company ❑ Copy Is filed with.the city. 0 Certified copy is h aPl"sh ; • .-•µ ,Qy .. BUILDING: TYPE CONST. OCC. GRP. ' A.P_. NumberX02-0 8. Legal Description ' • Project Description V. 30' tai ori fence Sq. Ft. No. No. DIN. . Size Stories Units New ❑ Add ❑ Alter ❑ Repair Q Demolition ❑ Estimated Valuation . M $260 { PERMIT AMOUNT Plan Chk. Dep. - Plan Chk. Bal. Const. Mach. - • Electrical Plumbing S.M.I. ' Grading , Driveway Enc. Infrastructure F TOTAL •• ' ' - CERTIFICATE OF EXEMPTIO WORKERS' COMPENSATION IN (This section need not be completed if the permit is for ' Or less.) : ... I certify that in the performance of tha work for whi p '3- employ any pparson in any manner so as to become sub Laws of California. Date' Owner,' r NOTICE TO -'APPLICANT: • If, alter making this Certificate subject to the Workers' Compensation provisions of. th comply with such provisions or this permit shall be deemed re back from Center Line ''j ✓' ack from Rear Prop. Line '. 1 ` r 'CONSTRUCTION LENDING A t Setback from Center Line .I hereby affirm that there is a construction lending work for which this permit is issued. (Sec. 3097, Civil Cod ck from Property Line r Lender's 'Name Lender's. Address ' This is a building permlt'when properly filled out, sign INSP OT qp ,r ?. !! expiration If work thereunder is suspended for 180 days.. ' I certify that I have read this application and state tha Date Permit ` I agree to comply with all city and county ordinances construction, and hereby authorize representatives -of mentioned property for inspection purposes. Signature of applicant +- = . •" 'Mailing Address'' City,, State„ Zip WHITE FINANCE PIN ICE HARD COPY, FILEst• _. ,-_..: 5-!r,,{•ty..«,:sr ,..,-s-:a•t y w _4;r,,., - w. ,.a:a:, '' ..a . .y:-.- .r,. rw ._..:•'_..r ir-t•,...__ sr.°:_., ; -_' `e CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL SO FT !p $ UNITS SLAB GRADE ROUGH PLUMB BONDING YARD SPKLR SYSTEM 2ND FL SO FT. !Q FORMS SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR SO FTa GAS (ROUGH) METER LOOP GAR SO. FT. C1 POWER OUTLET IROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SO FT. 6 GROUT WATER HEATER WALL SO. FT. (a FINAL INSP. DRINKING FOUNTAIN SO. FT. (a WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ _$ WATER PIPING NOTE; Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTONDISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRYTRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING 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 ' LATHING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A c SEWAGE DISPOSAL SO.FT.GAR (g Ii c HOUSE SEWER FINISH GRADING 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 APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus xE _$ 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 SIGNATURESIINITIALS , GARDEN WALL FINAL 7d