RR (11-0630) + PLGB (10327) + PAT (09098)53790 Avenida Madero
11-0630
10327
09098
P.O. BOX 1504 4 a(P
Qu&Z
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
416t-1951- 55 l LIES -1-10 l
Application Number: 11-00000630- Owner:
Property Address: ."•_53790 AVENIDA-MADERO LA QUINTA HOUSING AUTHORITY
APN: 774-143-002-23 -000000- PO BOX 1504
Application description: RE -ROOF LA QUINTA, CA 92247
Property Zoning: COVE RESIDENTIAL
Application valuation: 12199
Contractor:
Applicant: Architect or Engineer: CASTRO ROOFING INC
P O BOX 122
THOUSAND PALMS., CA 92276
(760)343-0042
LiC. No.: 828478
LICENSED CONTRACTOR'S 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 Co e, and my License is in full force and effect.
License Class: C39 LR` a No.: 828478
x Date: 4=6.1 0• 111, Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sed. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
v
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6109111
4"'--
JUN 10 2011 D
OF LA QUINTA
WORKER'S COMPENSATION DECLARATION
1 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 and policy number are:
Carrier STATE FUND Policy Number 0000147-2010
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 w f kgrs' compensation provisions of Section
3700 of the Labor Code, I shall forth% Wee ply th'those provisions.
Date: ol.- IQ- lc Applicant: - -
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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 corr ct. I agree to comply with all
city and county ordinances and state laws relating t construction, Ethorize representatives
of this county to enter upon the above-mentioned
Cpate: tb - 111D' ll Signature (Applicant or Agent)
Application Number . . . . 11-00000630
Permit . . .
RE -ROOF
Additional desc .
Permit Fee . . . .
30.00
Plan Check Fee
.00
Issue Date . .
Valuation . . .
. 0
Expiration Date
12/06/11
Qty Unit Charge
Per
Extension
BASE FEE
30.00
----------------------------------------------------------------------------
Special Notes and Comments
REROOF - SLOPED ROOF:
MONIER LIGHT
WEIGHT CONCRETE TILE
- CRRC 0942-0008
AND FLAT ROOF: 3 -PLY
BUILTUP (OVER
UNCONDITIONED SPACES)
2010 CALIFORNIA
BUILDING CODES.
June 9, 2011 4:13:53
PM AORTEGA
----------=-----------------------------------------------------------------
Other Fees . ... . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged
---------------------------
Paid
----------
Credited
--------------------
Due
Permit Fee Total
30.00
.00 .00
30.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
31.00
.00 .00
31.00
LQPERMIT
Prescriptive Certificate of Compliance: Residential Reroof CF -1 R-ALT-ReRoof
Project Address:
53-790 AVENIDA MADERO
Climate Zone
1 15
Permit #
1 11-0630
ROOFING PRODUCTS (COOL ROOFS) §151(1)12
When the area of exterior roof surface to be replaced exceeds 50% of the existing roof area, or 1,000 ft`, whichever is less, the new
roofing area must meet the roofing product "Cool Roof" requirements of §152(b)1Hi, 152(b)1Hii, or 152(b)1Hiii.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof' requirements::
M Cool roofs not required in Climates Zones 1-12, 14, and 16 with a low sloped roof pitch (less or 2:12 pitch).
0 Cool roofs not required in Climates Zones 1-9, and 16 with a steep -sloped roofs (greater pitch than 2:12) and product weightless than 5/lb/fl?.
Alternatives to §152(b)1Hi and §152(b)Hii, Steep -slope roof (pitch > 2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr•fe.'F/Btu or at least a 3/4 inch air -space is added to the roof deck over an attic; or
❑ Existing ducts in the attic are insulated and sealed according to §151(010; or
❑ In climate zones 10, 12 and 13, with 1 ft2 of free ventilation area of attic ventilation for every 150 f:2 of attic floor area, and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge; or
El Building has at least R-30 ceiling insulation; or
❑ Building has radiant barrier in the attic meeting the requirements of §151(f)2; or
❑ Building has no ducts in the attic; or
❑ .In climate zones 10, 11, 13 and 14, R-3 or greater roof deck insulation above vented attic.
Exception to §152(b)l Hiii, Low -slope roof ( pitch 5 2:12)
❑ Building has no ducts in the attic.
Other Exceptions
❑ Roofing area is covered by building integrated; photovoltaic panels and solar thermal panels are exempt from the Cool Roof criteria.
❑ Roof constructions that have thermal mass over the roof membrane with at least 25 Ib/ft2 are exempt from the Cool Roof criteria.
NOTE: If any one of the alternatives or exception is
products in §118(i) are not applicable. Do not fill table below.
Emittance requirements for roofing
NOTE: When a Cool Roof is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
Roof Slope
Product Weight
Product
Aged Solar
Thermal
Company: CITY OF LA QUINTA ate: JU E 9, 2011
CRRC Product ID Number'
s 2:12 > 2:12
:' < 5lb/ft2 z 51b/ft2
Type 2
Reflectance3A
Emittance
SRI
0942-0008
E3
El
1 '
M
TILE
E)4
.19
.91
18
0942-0008
E3
12
'M
E3
TILE
❑4
.19 •
.91
18
Note: If no CRRC-1 label is available, this compliance method cannot be used, use the Performance Approach to show compliance,
1. The CRRC Product ID Number can be obtained from the Cool Roof Rating Council's Rated Product Directory at www. coolroofs. oro/vroducts/search. PhD
2. Indicate the type of product is being used for the rooftop, i.e. single -ply roof, asphalt roof, metal roof, etc.
3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance value from the same
directory and use the equation (0.2+0.7(piei6ai — 0.2) to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check box if the Aged Reflectance is a calculated value using the equation above.
5. Calculate the SRI value by using the SRI- Worksheet at httD:1Avww.enerov.ca.gov/title24/and enter the resulting value in the SRI Column above and attach
acopy of the SRI- Worksheet to the CF -1R.
To apply Liquid Field Applied Coatings, the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(i)4. Select the applicable coating:
Aluminum -Pigmented Asphalt Roof Coating Cement -Based Roof Coating El Other
NOTE: When a Cool Roof is required, the installing contractor shall complete and submit the CF -6R -ENV -01 for final inspection.
Declaration Statement
• I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is accurate and complete.
• I certify that the energy features and performance specifications identified on this Certificate of Compliance conform to the requirements of Title 24, Parts
1 and 6 of the California Code of Regulations.
Name: AJ ORTEGA
Signature:
Company: CITY OF LA QUINTA ate: JU E 9, 2011
Address: 78-495 CALLE TAMPICO License:
City/state/zip:'LA QUINTA, CA 92253 Phone: (760) 777-7012
For assistance or questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300.
06/03/2011'.08:09 7603432097 CASTRO ROOFING INC PAGE 02
EXHIBIT .A
P.O. Boz 122, Thousand P31ms,.CA 92276
(760) 343-0042 * Fax (760) 343-2097
License 4828478
City of La Quinta
Re; Roof Estimate
53790 Avenida Madero
La Quinta, Ca 92252
Completely remove and discard existing roof, Substrate to be inspected for dry rot or defective plywood panels,
any found to be in need of replacement will be replaced at a rate of $2.00 per square feet upon approval of
owner or agents. Substrate to be inspected for loose or non -flush to deck sheathing nails, any found will be
driven flush, or completely pulled out, and re -nailed using a new nail at a new location. Substrate to be cleaned
and free of all debris, prior to new roof installation. Flat roof section: Install a built-up 3 -ply with cap sheet
consisting of installing cant strip on all roof to wall transitions and tapered edge cant strip on all crickets as
needed. Install l -layer #281b base sheet nailed to hold in place. Over base install 2 -layers #11 ply sheet
individually mopped with hot asphalt. On. top of new membrane, install primed pipe and vent flashings and set
in plastic cement nailed to secure. At perimeter install new metal trim. primed and set in plastic cement staggered
nailed at 3" centers. Seal top of metal with two layers of # 11 ply sheet, and hot asphalt All comers to be sealed
with Irish flax felt saturated with hot asphalt. Over entire watertight membrane install one layer of 972
fiberglass cap sheets, set in hot asphalt. Slope roof section: Over sheathing install new metal trim on perimeter
as needed. At roof valleys install one layer #40 felt. Over felt install new valley.metal.- Over sheathing on,sloped
roof install one layer #40 felt with primary pipe flashings nailed to secure. Over watertight membrane install
new Monier light weight tile espana California mission blend, with secondary pipe flashing to manufactures
Specifications. Mortar all hip and ridges as needed and install file trim. Paint all pipe and vent flashings to match
roof tile.
Total Amount: $12,1.99.00
Price to replace fascia board $4.00 a linear foot- exact amount to be determined.
TERMS: 100% UPON COMPLETION, UNLESS OTHERWISE SPF..CIFIED IN THE CONTRACT_
FIVE (5) YEAR GUARANTEE AGAINST LEAKS WILL BE EFFECTIVE UPON FULL PAYMENT,
THIS PROPOSAL WILL BE NULL AND VOID AFTER 5 DAYS FROM DATE SUBMITTED.
ALL DEBRIS CAUSED FROM ABOVE WORK TO BE DISCARDED AND AREA TO BE LEFT CLEAN. JOB TO BE STARTED IN .A TIMELY
MANNER ACCORDING TO SCHEDULE AND WEATHER PERMITTING.
ESTIMATE, DOSE NOT INCLUDES DISCONNECTING AND RECONNECTING ANY ELECTRIC, PLUMBING, GAS LINES AND MECHA.NICLE
EQUIPTMENT INLES OTHER WISE NOTED.
WE PROPOSE TO FURNISH AND APPLY LABOR, MATERIALS, PERMITS, TRANSPORTATION, & TOOLS NECESSARY FOR COMPLETION
OP ROOFING WORK.
DURING THE ROOFING PROJECT CASTRO ROOFING WILL MAKE AL1. ATTEMPTS TO MINIMIZE, BUT WILL NOT BE RF-SPONSIBLE
FOR DIRT. ROCK, OR DEBRIS THAT MAY FALL INTO LIVING AREAS. DAMAGES TO VENTS CONDUIT PIPES. OR CEILING MOUNTED
FIXTURES.
CONTRACTOR DOES NOT ASSUME ANY RESPONSIBILITY FOR CORRECTION OF EXISTING CODE VIOLATIONS OR FOR THE REPAIR
OF ANY EXISTING STRUCTURAL DEFECTS UNLESS SPECIFIED IN THE PROPOSAL CONTRACT. DOES NOT INCLUDE
ARCHITECTURAL, FNGINEERING OR EXTRA WORK IF REQUIRED BY CITY.
IN THE EVENT SUIT IS BROUGHT TO ENFORCE THE TERMS OF THE CONTRACT, THE PREVAILING PARTY SI4ALL RECOVER ALL
COSTS EXPENDED, rNCLUDING ATTORNEY FEES AS AN ELEMENT OF COST.
CONTRACTORS ARE REQUIRED BY LAW TO BE LICENSED AND REGULATED BY THE CONTRACTOR'S STATE LICENSE BOARD. ANY
QUESTIONS REFER TO: CONTRACTOR'S STATE LICENSED BOARD, 1020'W- STREET, SACRAMENTO, CA 95814.
IF THIS ESTIMATE MEETS WITH YOUR APPROVAL„ PLEASE INDICATE YOUR ACCEPTANCE BY SIGNING TMS COPY AND
RETURNING IT TO OUR OFFICE BY MALL OR FAX. WE I..00K FORWARD TO WORKING: WITH YOU.
Submitted by: Lha' J
- ,' Accepted By:
Richard Castro- President Owner agent
Submittal Date: June 3, 2011 Acceptance Date:
6►n l
Cit/ Of Ia Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
` ' ° O
Pro .ect Address: 163-I A%0641DR
Owner's Name: `4, "Pm. O
A. P. Number:
Address:,
0 SOS I
Legal Description:
Contractor: w,0
City, ST, Zip: Ljr. djt (j , g27,441
Telephone: c: :;>•:z :> r» t:«;i:>;s:: <;:
Address:
Project Description:
City, ST, Zip:
Telephone:
:f.;.
State Lic. # :
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Tele hone:>..,: ,,,;w>
P
.,.> ;;.
nn<,;s, :::.,:>?< :::
;;:4>:';:..:,ri;.i•.:•:.>::;.':a::>'<:><>:Occupancy:
:.in+t:ii:Fi:),:yi}{;{{+:'F:•>'i'i?>iki`::
Construction Type:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: AJ
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person: 'I .'j')'].'jVi9
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted 6
I
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
M HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
3 ,
•4
P.O. BOX 1504 N o . 10327
Building 53790 Madero78-105CALLEESTADO
Address LA QUINTA, CALIFORNIA 92253,
Owner
.dark Gordon
BUILDING: TYPE CONVS—
Mailing
OCC. GRP.
Address same
A.P. Number
City Zip Tel.
La Quinta 92253 Legal Description
Contractor
Project Description
RVS Plumbina SEWER HOOK UP
Address
P. O. Box 692
City Zip Tel.'
Rancho Mirage 92270 341--6546
State Lic. City
& Classif. C36 602396 Lic. # 1914 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
-- LICENSED/CONTRACTOR'S DECLARATION
I hereby _affirm lh I am la! ensed under Dr, visions of CI a ter 9 (commencing with Section
7000) of Division3 • f -the usi, e'ss a P o s9o`ns Cods and my license is in full force and
effect / A \ A
GNA U A I ` DATE
raWNER• ILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following 0 Q
reason: (Sec. 7031.5,Business 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 file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions or 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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.
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, Mech.
provided that such improvements are not intended or offered for sale. If, however, the budding
or improvement is sold within one year of completion, the owner -builder wig have the burden Electrical
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 30.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of propertywhobuilds or improves thereon, and who contracts for S•M-I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
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.)
Policy No. Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 30.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one -- ogars ($100) vaimban
or less.) i - s f p
I certify that in the performance of th work for which ^,, tjtt ..,' i ylf+f'F'ni 1 },'-4}-Y]rrt An
' rt
permit„is iss,0ed,'I shall not 1 f;
employ any Parson in any mann o as Vbe o "e s Eject the W6rkers',Compgnsation - -
Laws of California.
Date Own / /i
NOTICE TO APPLICANT: 1/, after rhak1n' rhi Certin ate o Exem tan you ukf become
ZONE: BY:
subject it the WorkerssCompensation provisions o me r'code, you must fomhwifh Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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. which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. S0. Ff.
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
BONDING
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FOUND. REINF.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REINF. STEEL
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
IBATH TUB
SO. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FINAL INSP.
SO.FT.GAR ® V4c
HOUSE SEWER
ROOFING_
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_
V '
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
COACHELLA VALLEY WATER DISTRICT
CASH RECEIPT DETAIL
'
Received From:
4
i
ate:
t Address: —
'
Account No.
Lot )
Tract
Service Address
. S• G.A. Code
0 Material
❑ Service(s)
# '
❑ Backflow(s)
❑ House Lateral(s)
❑ DetectorCheck(s)
❑ Meter Surcharge
_ Sanitation Capacity Charge
❑ W.S.B.F.C.
❑ Temporary Construction Meter
• .. . ❑ Tum on Charge
❑ Uncollected Account - Name
❑ Inspection Fee i Tract -
e
:
Fee -
Y
1
❑ Plan Check Fees Water Sewer -
'
;4 Tract -
)
❑ Bo . Payment = A.D. - Bond
t
L
1
t' Assmt.
' ❑ Cu T omer Deposit
I
s
f
t
❑ Othef i
{ Remarks:
D Copy to:
-
r
ash
J Water Service
(
Check
r
Money
Cashier
Order
CWNC- (11188)
4
P.O. BOX 1504 No. 09098
Building 78-105 CALLE ESTADO /
Address 53-790 Madero LA QUINTA, CALIFORNIA 92253
Owner
Mailing I
Address 53-790 Madero
City Zip Tel.
Contractor
Address
Zip
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
BUILDING: TYPE CONST. OC& GRP.
P. Number
4-2106 ILegal Description
CityI Zip I State I
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.
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
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 or 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).
AI as owner of the property, or my employees with wages as their sole compensation, will
the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
rofessions 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,
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
or 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 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. B. & P.C. for this reason
Date f% Ownerk %. 1-4
r r F' Y P'
r I# If 1
WORKERS' COMPENSATION DECLARATION
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.)
Policy No. Company
O Copy 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, 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 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
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.)
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.
Project Description PatMoco er
Sq. Ft.
Size
New ❑
No.
Stories
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
tstimateo Valuation
PERMIT
Plan Chk. Dep
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
AMOUNT
64.3
99.00
L
.56
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
Issued by: Date
Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
INSPECTOR
Permit
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
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 APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.CK.FEE
CONST. FEE ELECT. FEE
- SMI FE7 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 / 9/
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