SATT (9808-008)50940 Mango
9808-008
LICENSED CONTRACTOR DEWARP;TION ;
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the?Business and
Professionals Code, and my License is in full force and effect.
License ww,, 'c. Class Exp. Da,tejolo
Date 10 Signature of Contractor' " `Gtia .wa.F!
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and th6 structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier INMISTMAL IN'I71PW Policy No. €:.N3(4.=4
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject s the work' compensation witho a pvis Section 3 0? t?Labor
Code, I sh Il o wlt complywith those rovlslo ( /
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection p rpospp.
Signature (Owner/Agent) 1 Date
PERMIT#
8i)% .
BUILDING PERMIT CONTROL#
74C
DATEt>c' VALUATION 3 },Ci.9.x r LOT TRACT
6 9
JOB SITE :i bQ9 A9kt l`r lxtY
APN /fiY-rim&-moi /
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CJ%R1?tkL PACIFIC, 11011:JINOS INIC
CAPIF "Al. NX- CIx:IC Htyi rlL°'`S WC
.1100 Mt"3i; Alt'.€ HUR W%10 ix 00
4100 A,,D C:AftIMU[C B.iND 11200
Nlrs"'17dPt: KI' llE 13.1, CA, 8260
Nk W P01C1' f1'T ACH C.A. 92660
(714)02-9400 CRI.
USE OF PERMIT
r r-.°s<.zt 9
,v.rv. ,1111
OR II(YO .. K,A141CRU dr EI:E &Filytjv1,'b 9Y 75 v F€ R M.t3LTLPLE ISSIJANICL
OF SATME PLAN 'i'YI?E,
CiJS 't>ibL =14SIMUCTION 2,480.011 Si''
LStJRC;IMATIO 280.06 alp
cn s4:il1t;At3:Pt)i2,'► 327.fJf) Sly
EST151ATEED COS f OF CONSTRUCTION
20-9,205.20
COINSTItF.IO:L'1E, N FHE 101-000-418.000 S110.24.50
PLAN CHECK F M, 101 -M -4314 -Mg 11209 M 4
MECHANICAL '01. , 101-000-421-000 SrZ1)0
ME TIUCALEf, I.01-000-420-000 31.56.E
PLUMBTNO1 fwis" 101-OW419.000 $161.25
&JTtONG MOTION FIE, - .RRSID In t -000-211-O(X) $N,92
GRAD N10 FFM 10t-000-423-000 -S20.00
INFIRAS',t`.RUC'MREFEE:' 225-000-443-341 S4,623.334
PRECISE PLAN 101--000-441-345+ $2 !A
A.RT ':N P10-61MC MA.CFS -'RESM 701 4(l -2155-0(10 S273 01
SCJYVITfi'1'A (;0N9'MUU1f10N'.A.Nt7PLAN CHECK,
,°6,01.99
LIESS ME -PAID rEEs
$0,00
"TOTAL PERMIT :t+ FE.S. 01JE, NOW
$6,611.99
RECEIPT / ,,+ ,,,,y
DATE,
DAT
FINALED
INSPECT j
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
G 0=� �0 /Q!�
Underground Ducts
Forms & Footings
Ducts
Slab Grade
_ _ _�6,� _
Return Air
Steel
Combustion Air
Roof Deck�/�
Exhaust Fans
O.K. to Wrap
'/ ! `
«<!�
F.A.U.
Framing
Compressor
Insulation
_
y
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
�f _
Drywall - Int. Lath
Final
Final
_
=yZcf� ��
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_ _
�. Z=
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection!
��_�/1
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
_
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Furfures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
TitIt at 4 Q"
P.O. BOX 1504
Building ' 78-105 CALLE ESTADO
Address `940 amlEcfiit LA QUINTA, CALIFORNIA 92253
Mailing
Address 12526 H N$Qh Bluff df. Suite MO
City Zip Tel.
San Diego 92130 481uW0
Contractor
Address
Tel.
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address
City IZip I State
& Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby fi at I ice sed under provisions of Chapter 9 (commencing with Section
7000) of Di iS n q Busi Lss and Professions Code, and my license is in full force and
effect. I ! I t1
OWNER•BUILDER DECLARATION
re
I hereby affix that I am exempt from the Contractors License Law for the following
reason: (Bert. 703 .S,B mess and Pro/essions Code: Any city or county which quires a
pe((mit
to
co slruct, alter, improve, demolish, or repair any structure, prior to its issuance also
req'1ri es the plicant for such permft to Zile a signed statement that he is licensed pursuant to
the 11-01
i"On o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
Division 3 0/ the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation o/ Sectfon 7031.5 Dy 'any applicant for a permit
subjects the applicant to a civil penalty o/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. I/, 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 /or the purpose of sale.)
O 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 o/ 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.)
PolicyNo.—.--.Company
py is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($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: I/, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
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. 07795
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number Citrus Course
Legal Description Traci 24890-2 Plan 2B
Project Description Lot 39
Sq. Ft. 255
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$1879400
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
M 52
Const.
Mech.
Electrical
225
69
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
tfllt t,ttalt V a
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 5/4/90Permit
Validated by:
Validation:
CCNSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. .• SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. 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
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/a 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.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
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