Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
BPLB2015-0010
79605 Mandarina BPLB2015-0010 14831 14828 14373 07778 13530 78-495 CALLE TAMPICO' C1 0 D "i KMU iI/ LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPLB2015-0010 Property Address: 79605 MANDARINA APN: 776191026 Application Description: REPLACE (1) 50 GALLON GAS WATER HEATER IN GARAGE Property Zoning: LA QUINTA, CA 92253 Application Valuation: $3,100.00 Applicant: A R S AMERICAN RESIDENTIAL SER 965 RIDGE LAKE BLVD STE 201 MEMPHIS, TN 38120 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 Professions Code, and my License is in full force and effect. License Class: C36, C42, A License No.: 765155 ""`-" Date; Z I Contractors 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 (Sec. 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 ($500).: (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. . B.&P.C. for this reason Date Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/21/2015 Owner: CLARE, PATRICIA REAY/ CLA C 79605 MANDARINA LA QUINTA, CA 92253 rn 0 n Contractor: m Z ' o A R S AMERICAN RESIDENTIJ n 965 RIDGE LAKE BLVD STE 2$ Ui MEMPHIS, TN 38120 (901)271-9700 Llc. No.: 765155 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. IF `Y 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 issued. My workers' compensation insurance carrier and policy number are: Carrier: _ Policy Number: _ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DaIt J` I Applicants 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 Building Official 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 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 u Vt bov mentioned! property for inspection purposes: Date: ` 2 Isr Signature (Applicant or Agent). FINANCIAL • DESCRIPTION ACCOUNTEO • AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $7.25 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PLUMBING FEES: $19.34 $0.00 TOTALS:0i Description: REPLACE (1) 50 GALLON GAS WATER HEATER IN GARAGE Type: PLUMBING Subtype: Status: UNDER REVIEW Applied: 1/21/2015 SKH Approved: Parcel No: 776191026 Site Address: 79605 MANDARINA LA QUINTA,CA 92253 Subdivision: TR 24890-2 Block: Lot: 4 Issued: Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $3,100.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NAME TYPE Details: WATER HEATER CHANGE OUT - 50GALLON/GAS [2013 ENERGY] CARBON MONOXIDE ALARM(S) TO BE INSTALLED PRIOR TO FINAL INSPECTION. 2013 CALIFORNIA BUILDING CODES. CHRONOLOGY CONDITIONS CONTACTS NAME TYPE NAME, ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT A R S AMERICAN RESIDENTIAL SER 965 RIDGE LAKE BLVD STE 201 MEMPHIS TN 38120 (760)999-2116 CONTRACTOR A R S AMERICAN RESIDENTIAL SER 965 RIDGE LAKE BLVD STE 201 MEMPHIS TN 38120 (760)999-2116 OWNER CLARE, PATRICIA REAY/ CLARE TR 79605 MANDARINA r LA QUINTA CA 92253 (760)999-2116 Printed: Wednesday, January 21, 2015 1:35:33 PM 1 of 2 Cor SYCTF M.S INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES PLUMBING FINAL" CLTD DESCRIPTION ACCOUNT QTY AMOUNTR PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: PERMIT ISSUANCE 101-0000-42404 1 0 1 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 WATER HEATER/VENT 101-0000-42401 0 $12.09 $0.00 WATER HEATER/VENT 101-0000-42600 0 $7.25 $0.00 PC Total Paid for PLUMBING FEES: $19.34 $0.00 TOTALS:00 INSPECTIONS SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED DATE DATE RESULT REMARKS NOTES PLUMBING FINAL" PARENT PROJECTS BOND INFORMATION ATTACH M E NTS Printed: Wednesday, January 21, 2015 1:35:33 PM 2 of 2 CYSTFAA.0 Bin City of La Q uln to . Building &r Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico . U Quinta, CA 92253 - (760) 777-7012 > LgZD j p Q Building Permit Application and Tracking Sheet Project Address: N Owner's Name: L L49-'C A. P. Number: Address: 9490 M CA ?—I N 4 Legal Description: City, ST, Zip: t-A- QJc nl fig 253 Contractor: - C- "S- ,,a v ' d "fC Telephone: a( i I 0 p 7fp O °I Z ?'•..>`• :€`<'>'s`:> .;:.:::•:: Address: S;Z O 1113 .-i`- S Project Description: W QaGLt. I h City, ST, Zip: ` %Lvl/t✓(L S 1 r 2 t % I 4 S 4✓ ✓ Q Telephone: L 3[ 3 ................................ r r State Lie. #: & City Lie. Arch., Engr., Designer: Address: City, ST, Zip: Telephone: :::> :;:<. > Construction Type: Occupancy: cY• State Lie. #: Project type (circle one): New Add, n Alter . Repair Demo Name of Contact Person: D Sq. Ft.: # Stories: #Units: Telephone #,of Contact Person: Estimated Value of Project: 3 p O APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal . Req'd Rec'd TRACKING PER FEES Plan Sets PIan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. 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 IN FIOUSE:- 'rd 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 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06114 CALIFORNIA ENERGY COMMISSION all CERTIFICATE OF COMPLIANCE CF111-ALT-01-E Prescriptive Residential Alterations (Page 3 of 4) Project Name: -JR(nK N 0 0-0-(N r, Vo) 11 Date Prepared: Z t f b F. SPACE CONDITIONING(SC) SYSTEMS - HEATING/COOLING (Prescriptive section 150.2(b)) 01 02 03 Dwelling Unit Name Dwelling Unit CFA (Ft2) C omrl:45 p, 1 0 AN ,-x G. WATER HEATING SYSTEMS (Section 150.2(b)1G) 01 02 03 04 05 06 07 08 _ 09z 10 q1Q 2 —12 13 14 15 SysteIdentification or —Water.Heating Alteratitm to the Space Water Name ,s {Identification or Name Conditioning System(s)? Comments .(ft2 Water Heating f of Water Heater + j Q? Back -Up System Water Water Heaters Storage Rated Rated put Heating '00yyy %Heating 44 4,, EEf fic.ci ent y Exterior Solar DHW Dwelling Unit DHW System Identification or Heating Heater in Volume Fuel Input dI Value Efficiency ( Standby Insul. Savings Central System Name System Type Type system (gall Type Type, Typelt , Value Loss,O R -Value Fraction Distribution Type Distributi n Type I 1I KL fnl }{fin ij Q,7} ._- v WN' sus _ !c 41V 1 H. SPACE CONDITIONING SYSTEMS AND WATER HTkN~,G SYSTEMS INk1MULTIFAMI%D—W- EL LING UNITS 01 02 03 ` .. 041" 05 06 ' v Central Water -Heating, i )a D4',elling Unit System Dwelling Unit: DwellingUnitTotal CFA SysteIdentification or —Water.Heating Alteratitm to the Space Dwelling Unit Name Name ,s {Identification or Name Conditioning System(s)? Comments .(ft2 Registration Number: CA Building Energy Efficiency Standards - 2013 Residential Compliance Registration Date/Time: HERS Provider: June 2014 STATE OF CALIFORNIA RESIDENTIAL ALTERATIONS CEC-CFIR-ALT-01-E Revised 06/14 CALIFORNIA ENERGY COMMISSION 'A.W CERTIFICATE OF COMPLIANCE CF1R-ALT-01-E Prescriptive Residential Alterations (Page 4 of 4) Project Name: 79/,09— 044i0it -k- t, - %kl Date Prepared: DOCUMENTATION AUTHOR'S DECLARATION STATEMENT ... 1. 1 certify that this Certificate of Compliance documentation is accurate and complete. 10 A. 1 Documentation Author Nam ,z GLS Documentation Author Signature: ` v s Company:r/% Signature Date: (nzr/. Address: 5III( T CEA/ HERS Certification Idepfi i at on`(if applicable f ! ) V r m,, City/State/Zip: Phone: L'lb t v . t RESPONSIBLE PERSON'S DECLARATION STATEMENT ^ _ + 's` ► I certify the following under penalty of perjury, under the laws of the State of California:q l"' " 0 1. The information provided on this Certificate o(Compliance is true and correct. ' 2. 1 am eligible under Division 3 of the Business and Professions Code to accept responsib«ilityy for the building d e sl or system design identified on this Certificate of Compliance (responsible designer). 3. That the energy features and performance specifications, materials, components and manufactuqrre' d`evicees, or the building design or system design identified on this Certificate of Y • w v ry' • ' af Compliance conform to the requirements of Title 24, Part 1 and Part 6 of the California Code of` Regulations. fes' Naz 'on a documents, 4. The building design features or system design features identifiedthis Cdrtificate of Compllance are consistent•w thyth, information provided on other applicable compliance ncy'for}approval this b'u ding worksheets, calculations, plans and specifications submitted to the enfo cement age with permit application. with p m for 5. 1 will ensure that a registered copy of this Certificate of Co mplianc shfall be madeatvaillable- the building t(s) issued the building, and made available to the enforcement agency building for all applicable inspections. I understand that a registered eopy'of this Certificaw f Compliance is requlred'to be included with the documentation the builder provides to the owner at occupancy. . # Responsible Designer Name:. Responsible Designer Signature: ,,ggff33 Company: .4 ~ `e+ `;} Date Signed: Address: License: City/State/Zip: "' Phone: O si For assistance or -questions regarding the Energy Standards, contact the Energy Hotline at: 1-800-772-3300. Registration Number: Registration Date/Time: HERS Provider: CA Building Energy Efficiency Standards - 2013 Residential Compliance June 2014 a Av. . 114, is P, 0 1 Me. . 74* IT Building 79_605 Handarina Address Owner Roger & Karen Peck Mailing 5aMe Address City Zip -La Quinta, CA 92253 Contractor Mike Boren Address 1707 Virginias P1. city CAi zip 92690 Placentia, P.O. BOX 1504 78-495 CALLE TAMPICO LA OUINTA, CALIFORNIA 92253 771-5502 10524-6904 State Lic. I City & Classif. B 535521 Lic. # Arch:,- Engr., Designer Address Tel. City( Zip I 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 Iicense is in full force and ,.effffectr r i$1GNATURE DATE OWNER -BUILDER DECLARATION I hereby affirfn that I am exempt from the Contractors License law for the following reason: -(Sec. 7031.5,Business and Pmtesslons Code: Any city, or county which requires a permit to construct, after, Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to lie a signed statement that he is licensed pursuant to the provisions of the Contractor's license Law, Chapter 9 (commencing with Section 7000) or Division 3 of the Business and Professions Cade, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500). ❑ 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 inprovements are not intended or offered for sale. ff, however, the building or improvement is sold within one year of completion, the owner -budder will have the burden of proving that he did not bund or improve for the purpose of safe.) ❑ 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 reproves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ I am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3900, Labor Code.) Policy No. Company ❑ 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 perm is for one hundred dollars ($100) valuation or less.) 1 certify that in the performance of thg work for which this permit is issued, I shall not employ ploy any person in any manner so as to become subject to the Workers' Compensation Laws of California Date Owner f NOTICE TO APPLICANT. ft, 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 pemut shall be deemed revoked. 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 (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. This is a building permit when properly filled out, signed and validated, and is subject to 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. 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. 14831 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description enclosure Move plumbing and the shower Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $8r200.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 27.04 Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 27.00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Rear Setback from Rear P Ine Side Street Setback fro ter L' Side Setback from Pr y line FINAL DATE I CTOR 9 ` Issued by: Date iPermit 3 Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. p POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SQ. 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 APP.IEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE 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 SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+A c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER REMARKS: 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 ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. REINF. STEELf_PAS (FINAL),C 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 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 tU 44 P.O. BOX 1504 No . '14-828. Buildin78-495 CALLE TAMPICO Address 79-605 Mandarina LA QUINTA, CALIFORNIA 92253 Owner Roger Peck . Address Same City Zip Tel. La Quinta E CA 1 92253 Albrights A/C Address . P.O. Box 1024 Zathedral City;' -CA 92234 328 -25038 State Lic. 5664-22— City 2815 l7-3L/c7 Lic. # Arch., Engr., Designer Address I Tel. CityI Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION 4j er p I hereby affirm that lam licensed undrovisions of Chapter 9 (commencing with Section MJ 7tof Division'3 of the Business and.Professions Code, and my license is in full force and' SIGNATURE - DATE 11 OWNER -BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a Permit to construct, atter, 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 five hundred dollars ($500). O 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 buil! or improve for the purpose of sale.) . ❑ I, as owner of the property, am exclusively contracting with licensed contractors to com. 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 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 Company opy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that In the performance of thg work for which this permit is issued, I shall not employ anypperson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT- H, 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. 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. This is a building permit when properly filled out, signed and validated, and is subject to 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. 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 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Installation of swamp cooler with ductwork to each room Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $3,500.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. 26.00 Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL 26.00 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Line Side Street Setback fr nt Line - P Side Setback from P y L'ine FINAL DATE PECTB R a Issued by: Validated by: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. FOR. SQ. FT. ® GAR. SO. FT. ® CARP. SQ. FT. WALL SQ. 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 WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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. SQ. FT. ® c BATH TUB / L—INSP.v SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 114 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE FIRE ZONE ROOFING 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. / L—INSP.v FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING 01 INAL INSPECTIO CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL 2-C- o 4 Y , - 6 W -A L-, e; 4 r- - !-=.p 0k: I , D C) C) -T L L: 1,,:5 i;,. L -D -2--u O'L'l L - (:,,r -o —T, c hl`- S TAt( t44Q" P.O. BOX 1504 Building 79-605 Handarina 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 Owner J.M. Petar t Mailing 3501 Jamboree 4200 Address City Zip Tel. Newport Beach, CA 92658 1(714)854-2500 CO TKT-brnia Pools & Spas 'M910 Boardiialk ' Suite A-2 City Zip Tela Palm bese>rt, A 92260 340-9000 State Lia C53 185142 city 355 & Classif. Lic. # Arcn., tngr., Designer Address CityI Zip I State I Lic. # LICENSED CONTRACTOR'S DECLARATION . 1 herebyaffirm that -1,amrt e .liced undeaprovisions of Chapter 9 (commencing with Section 7Myofivision 3, Lthe BueinessOa ` Rrofesstohs'Cod e -an my license is in rc full f 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,Business and Professions Code: -Any city or county which requires •a permit to construct, after. Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than rive hundred dollars ($500). O I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 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.) Polic rNo. -Company Mclopy 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 parson In any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: d, 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. 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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. 14373 BUILDING: TYPE CONST. OCC. GRP. P. Number Description t Description Pool and Spa Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ *13,OO .00 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS AMOUNT 93'r6fi 3.60 14+1x$8 144.00 24.00 45.00 27.00 333.60 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. PLUMBINU FEES IST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SO. FT. ® CAR P. I SQ. FT. WALL SQ. 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. LAUNDRYTRAY 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® l Y. c SEWAGE DISPOSAL SQ.FT.GAR ® 3/.c HOUSE SEWER REMARKS: 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURE&INITIALS GARDEN WALL FINAL 7d T- &-t 4 4QurKrw P.O. BOX 1504 Building 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner maning I Address 12526 High Bluff Suite 280 City lZip ITel. 42130 1 481 -OW Contractor City State Lic.I City & Classif. Lic. # Arch., Engr., Designer Address Tel. CityI Zip I State Lic. # CONTRACTOR'S DECLARATION under provisions of Chapter 9 (commencing with Section and Professions Code, and my license is in full force and OWNER -BUILDER DECLARATION I hereb affi that I am exempt from the Contractor's License Law for the following r ason: (Se 70 1.5,t3usiness and ProfessionsCode: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the plicant for such permit to file a signed statement that he is licensed pursuant to the provision of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by -any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) O 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 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.) 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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. -- o. Company Qopy 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. Signature of applican Mailing Address_ City, State, Zip_ No. 0?778 LDING: TYPE CONST. OCC. GRP. - P. Number Citrus Carse !gal Description Tract 24890-2 PlanIA oject Description Lot 23 Sq. Ft. 2439 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $178450 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. 9116.00 Mech. MAn Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure 4017.38 TOTAL REMARKS _ 4051i . 1? 94L4=41:4-3-'Nw.n .. it; 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 6/4JNPermit Validated by: Validation: CCNSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FLS SQ. FT. (d POR. SO. FT. ® GAR. SQ, FT. ® CAR P. 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. LAUNDRYTRAY 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. 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 ® V4c HOUSE SEWER R ARKS: y/1/J B4✓ 13 0 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 ROCKSTORAGE 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 R ARKS: y/1/J B4✓ 13 0 VENTILATION FIRE ZONE ROOFING d( /@ ' FIREPLACE 0-0' SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL P.O. BOX 1504 APPLICATION ONLY Building r CALLE CALIFORNIA 92253 Address '4M^%T_/-/ALAQUINTA, Owner rr ^^ n t_ _ S + BUILDING: TYPE CONST. OCC. GRP. Mailing Address 3 S0 ` A.P. Number City Zi , Tel. .a % Zirsj C -/1y) A f/• -L D 49 — 7 67„ Q Legal Description Y G/- Contractor^ ,Ayc A', dw Project Description n F1'/i'tr Pz L- Address Address /V T City Zip Tel. State Lic. 2 & Classif. J I 13 —I City Lic. # Sq. Ft. Size j No. No. Dw. Stories Units / Arch., Engr., p Designer J t v New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O AddressL✓ I OV ul 'r' /y State Lic. #CXIAIC LICENSED CONTRACTOR'S DECLARATION I hereby affirm t at I am Iicensed mder provisions of Chaptero9 (commencing with Section 7000) of Divisio ti 3 of,1Ke Busir)e$s and Professions n I se is in full force and effect. 21 SIGNATURE ,rr A / -- % DATE (/ OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or countywhich requires a PERMIT AMOUNT 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 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 five hundred dollars ($500). Plan Chk. Bal. 1] I, as owner of the property, or my employees with wages as their sole compensation, will Const. do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Code: The Contractor's License Law does not apply to an owner of property who Mech. 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 Electrical 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.) Plumbing II 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 to builds improves thereon, for S.M.I. not apply an owner of property who or and who contracts such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading I1 1 am exempt under Sec. B. tx 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 Co n ion lnsu, nce, or i co7S;Doj,_LSec. Ol jr or CodeP ycert' Polic No. // AA// r(( L i/v ❑ Copy is filed with the city. O Certified copy is hereby furnished. TOTAL S CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed if the permit is for one hundred dollars ($100) valuation of less.) I certify that in the performance of Ing work for which this permit is issued, I shall not Anl:Z4 7 4,'W 7004 A4 _f}S_O^) i t _... - employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. i _ . CASH i TOTAL i. raj©, Q0 Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you Must forthwith comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances: 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 FINAL DATE INSPECTOR Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to 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 sof this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT..0 $ 2ND FL. SO. FT. @ POR, SO. FT. C GAR. SO, FT, CRR P. SD. FT. 0 WALL SO. -FT. 0 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 APP.IEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB SO. FT. p c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 I c SEWAGE DISPOSAL SO.FT.GAR a ?AC HOUSE SEWER REMARKS: 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 APP.IEOUIP. 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESlINITIALS GARDEN WALL FINAL Tity/ 4 4 a" Building 79-605 Mandarina Owner J.M. Peters Co. P.O' BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailin Address 3501 Jamboree Road City ZipTel. Newport Bea h, CA 9265 (714}854--2 Contractor Same Tel. State Lic. B-1 3108£8(City 1503 & Classif. Lic. # Desi nergr 9 Berkus Group Address Tel. Way 0 Corporate Ta (714)261-82 City Irvine, CA Zip 92714 Lic.# C6885 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. -ir Y, k I `t j{ 1 "{ 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,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 of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500). ❑ 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.) 0 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 of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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 Nq'. Company CWbo y is filed with the city. 0 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 (8100) 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 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 it 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. 13530 BUILDING: TYPE CONST. V%"' OCC. GRP. R3 A.P. Number 769-490"683 Degal Description Lot 23 Tract 24890„2 Project Description SPA Duplex Plan 1 Citrus Sq. Ft. 2439 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ 2 Estimated Valuation $194,335.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 792.16 Const. 972.00 Mech. _ 62„00 Electrical 158.73 Plumbing 168.00 S.M.I. 19.58 Grading 20.00 Driveway Enc. .00 Infrastructure 4,309.11 Arts in Public Places 2 5.$ R TOTAL 6,737.34 REMARKS ! l r ` !1, 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 .T COLL. AREA SLAB GRADE 9S T'FL. SO. FT. ® $ UNITS HEATING (ROUGH) • n FORMS SEWER OR SEPTIC TANK 2ND FL. SQ. FT. DUCT WORK YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT.'® POWER OUTLET ROOF DRAINS CARP. SQ. FT. TEMP. POLE DRAINAGE PIPING WALL SQ. FT. GROUT DRINKING FOUNTAIN. SQ FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM WATER PIPING NOTE: Not to be used as property tax valuation =$ FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM 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 GAR. FIREWALL SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® V4c HOUSE SEWER 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL C 1 ~ CITY OF LA OUINTA f OI ~ DEPARTMENT OF PLANNING & DEVELOPMENT BUILDING DIVISION 24-HOUR NOTICE FOR INSPECTIONS 777-710113(0FLAUUINTA Owner J.M. Peters Co. 11 14 Contractor Same Permit Number 13530 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 79-605 Mandarina 40& Lot 23 P��\ TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK .FOOTING STEEL s MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED JOISTS & GIRDERS I I ELECTRICAL GROU D WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST . HEATING & VENT- A/C FIREPLACE �. BOND BEAM " O.K. TO WRAP - • c, GROUT ❑ 4' ❑ 8' FRAMING 177- l INSULATION PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK rtU/--� --)v 1 J. 24 <iL/ - Gf ELECTRICAL Z 7, PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED f -< z- -7 �C /v-- /v- 6561 ' ; ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING 4188 N P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address 79-615 1Mandari a LA QUINTA, CALIFORNIA 92253 Owner J.H. peters Rudolph Address 3501 Jamboree Road, Ste. 200 City Zip Tel. y Newport Beach, CA 9066 1564-1485 Contractor California Pools a Spas tdltlr`710 - Boardwalk A--2 Git ' Pam Desert, CiZip 92261 Tel 34o-�t3�i# State Lic. City & Classif. C-53 185102 Lic. # 355 Arch., Engr., Designer Address Tel. City (Zip ( State Lic. # ! LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 amlicerfsed under provisions of Chapter 9 (commencing with Section 7000) of Divislo;Sotithe�Beiness and Professions Code, and my license is in full force and effect. 1 r OWNER -BUILDER DECLARATION I hereby ffum that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, 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 or 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 of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and .Professions Code: The Contractor's License Law does not apply to an owner or property who builds or improves thereon, and who contracts for such projects with a contractor(s) (lcensed pursuant to the Contractor's License Law.) ' ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner J 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 / I Company opy is(fite with the city. 0 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. DateL--Owner NOTICE TO APPLICANT: ff, 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. 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. This is a building permit when properly filled out, signed and validated, and is subject to 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. 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. 24594 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Lot 22 (Project Description Spa Only Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $6000.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 52.65 Const. 81.00 Mech. 24.00 Electrical 45.00 Plumbing 27.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL 229.65 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:_ Validated t Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINi; FEES 1ST FL. SO. FT. ® $ 2ND FL. SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. I S0. FT. WALL S0. 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 APPIEOUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/<c HOUSE SEWER REMARKS: 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 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 REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION -?-Z-� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES11NITIALS GARDEN WALL FINAL T-4.hf 4 4 QUIAM Building 79-155 tKandarina Address Owner J.H. Peters Mailing Address 41-910 Boardwalk 'Alm Desert, t'ift;p 92260 Cojrltr, ctor c.arizornia Pools & Spas Address 41-910 3oardualk P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 No. 13666 BUILDING: TYPE CONST. OCC. GRP. A.P. Number 64-1+465 Legal Description Project Description Pool and Spa `'hlm Desert, p 9226Ez lel3l}t0-9000 &tCIa sif. C53 185102 LLiicy# 355 Arch., Engr., Designer D. Ferroll Address Tel. Sante City Zip State Lic. # RCE 3299 LICENSED CONTRACTOR'S DECLARATION 701 hereby affirm that I am lic sedunder provisions of Chapter 9 (commencing with Section 00) of Division 3 0 siness and Professions Code, and my license is in full force and '"effect. I !! r _SIGNATURE DATE V OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, 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 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 of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose or 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 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 i WORKERS' COMPENSATION DECLARATION 1 hereby arfir t I have a certificate of consent to self -insure, or a certificate of Worker's Com 'e lion Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ 6dopytiled with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WO RKE RS' 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 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 Sq. Ft. Size New ❑ No. Stories No. Dw. Units Add ❑ Alter ❑ Repair ❑ Demolition ❑ stimated Valuation $13t500.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 99.45 Const. 153.00 Mech. 24.00 Electrical 45.00 Plumbing 27.03 S.M.I. Grading Driveway Enc. Infrastructure TOTAL $ 48 . 45 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 1 �t� i FINAL DATE- JUN 2 INSift*R J ' Issued by: —Date ) Permit Validated by: - —J Validation: 0 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS A.C. UNIT COLL. AREA YARD SPKLR SYSTEM 2ND FL. SQ. FT. ROUGH PLUMB. BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK FOR. SQ. FT. ® SEWER OR SEPTIC TANK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. Q. FT. ® METER LOOP HEATING (FINAL) WALL SQ. FT. DRINKING FOUNTAIN. SQ FT @ GAS (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES FINAL INSP. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LUMBER GR. LAUNDRYTRAY AIR HANDLING UNIT CFM FRAMING 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. SQ. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER SPARK ARRESTOR GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK 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 ROCKSTORAGE 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 REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING �f /// FINAL INSPECTION1, L/ f1/ Y e CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Building Address Owner T 0 0 4hf 4 4 a" 79-615 Mandarins J.H. Peters Co. P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 3501 Jamboree Pond CityZip Tel. Newport Beat , CA 9265 (714}854-250 State Lic. B-1 310868(City 3503 & Classif. Lic. # Arcn., tngr., $erkus Group Designer AddT& Corporate way Tel.{714}261-82 cjtyzrvine, CA (zip 927141Lct# C6885 1 LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I em licensed under provisions of Chapter 9 (commencing with Section 7 00) of Diyision 3 of the Business and Professions Code, and my license is in full.force71 8ffect.1'. 7 ' r —{ `yC. � / 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,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 of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500). ❑ 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, Bussness and 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, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner 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 I� . Company C� 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 (8100) 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 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 This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that 1 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. BUILDING: TYPE CONST. VN OCC. GRP. A.P. Number 769-"490-'009 13529- . . Q Description Trot 22 Tract 24890-2 Description SETA Duplex Plan 3 Sq. Ft. 2747 No. Size Stories New ❑ Add ❑ Alter ❑ No. Dw. Units Repair ❑ (Estimated Valuation $216,400.00 PERMIT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure Arts in Public Places TOTAL REMARKS Demolition ❑ AMOUNT 862.27 1„049.00 102.50 y172.41 174.04 21.70 20.00 .00 4,340.76 291.20 7..53:3.83 i 1 1rr1 t �f ZONE: BY: f 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. _Z SQ. FT. ® $ UNITS SLAB GRADE A 2NDD FL. SQ. FT. " BONDING YARD SPKLR SYSTEM POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. GAS (ROUGH) DRAINAGE PIPING WALL SQ. FT. OTHER APPJEQUIP. DRINKING FOUNTAIN. SO. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL GAR. FIREWALL SO.FT.GAR ® 3/ac HOUSE SEWER LATHING 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 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