RPL (0301-390) + BLCK (11597)44675 Marguerite Ct
0301-390
11597
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # - Lic. Class Exp. Date
650 d 3 C:)3 iK c rsed 1NX) /04
F f
Date ! '? • ' Signature of Contractor ''/ .
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 the {structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() 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),b 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 I17'ATZ
I., Policy Policy No. A44)43-2003
(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 to the workers' compensation -,provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions',,,?
Date: t. i , r. ?, Applicant e 4 2fi J {
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 purposes.
Signature (Owner/Agent) af'i're'., .. Jar 4 Date
-BUILDING PERMIT PERM&T"
GATE VALUATION i R LOT TRACT 376'
JOB SIT
ADDRESS " F.t?". ras ..}:2.7.% .;Li. t' APN _
OWNER CONTRACTOR / DESIGNER / EN &NEER
- i
a 'MS CIT)P MAN Co W9
Qu. f 'cy f f t• : •3 ,C t'' A • 3
.9.J :. . rW ad t'. b.Ci.. :.rS' . .. 5..7 fi': ,.,s r.•. 1:.Jw`1. E7f .f. CAiJF3' '
f
USE OF PERMIT
i':.5' I t/: l'.r r.C ? i• J . Y S'YYt L'.ri! •a .4:r{t.",.C, ais'I Jr F.V tf .S t' t •ivZ,%C.).,2.
'' 5311 1"Fly. FfiWRITAIty
PLAN G3eGIcRL
LONIS1RUCTICWyp y 1;101 -n000{ 4 D C "•'y°i0 8y
t QtY. U
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EC,3416"ICAI,'wW,F - IFCD L 10 -000
PL;"t11dSli1WJ.FV1Ii. . POOL 301wtIT10-t-19-t)1,7a
I RECEIPT
' J.a<'s M.74 : `.lir" X" .l!J x"! -e •',* . .'
a
DATE' BY'
If3A9 All
$0.0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain •
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final.
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
" - P.O. BOX 1504
No. 11597
Building 78-105 CALLE ESTADO
Address 44-675 MARGUERITE LA QUINTA, CALIFORNIA 92253
CHARLES WHITE
Mailing
No. No. Dw.
Stories Units
New ❑ Add ❑
Address SAME
City
Zip
Tel.
LA QUINTA
92253
Contractor
Estimated Valuation
H—AMILTON MASONRY
PERMIT
Address
Plan Chk. Dep.
P O BOX 1771
const.
City
Zip
Tel.:
LA QUINTA
92253
345-7659
State Lic.
.S.M.I.
City
& Classif. 591684
Lic. # 1631
Arch., Engr.,
Infrastructure
Designer
Address
I Tel.
City (Zip (State
Lic. #
1 LICENSED CONTRACTOR'S DECLARATION
I herebyiaffirm that I am,licensed under provisions of Chapter 9 (commencing with Section
7000) o'ff''Division 3 off/the` Buusiiness and'Prrooffessibns Code, and my license is in full force and
sr SIGNATURE r DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: i($ec. 70.3 1.5, 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 or 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 or completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.) '
b 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.)
O I 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. .Company
0 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 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 1I 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description 75' X 6' BLOCK WALT.
Sq. Ft.
Size
I
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$1s875.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
const.
$45.00
Mech.
Electrical
Plumbing
.S.M.I.
U
Grading
Driveway Enc.
Infrastructure
t
TOTAL
$ • dC7
REMARKS
<riv ax, It 1 115
ZONE: - BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line'"
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date - Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
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 ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION�J
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
/ f/ Ah
REMARKS:
VENTILATION�J
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
4:4
t P.O. BOX 1504. c No. 0830 •
Buildin 78-105 CALLE ESTADO
Address $ 'I ZI n rt LA QUINTA, CALIFORNIA 92253
Owner ,
"
Mailing
, fr c BUILDING:- TYPE CONST. OCC: GRP.
Address j A -1--a7 iu natdin St. A.P. Number Trpu-t 24M — Phan*-- I
City Zip Tel.
.: 2 ' 7541 Legal Description F.eaet"Fg Bluer
Contractor.. . 1 -M.
Project Description f2r - ?mit 62
Address0 H113104"s D=. Corps
. i-, -
City ♦ Zip
State Lic.- City
& Classif. -4939,1 Lic. # 1231 Sq. Ft. 1621 No. No. Dw.
'
Size Stories Units
Arch.; Engr:,
Designer;. New ❑ Add ❑. Alter ❑ Repair ❑ -Demolition ❑
Address Tel.
City s Zip State
P.C. #
' - 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 Contractor's License Law for,the following Estimated Valuation '
reason: (Sec. 7031.5,Business and Professions Code:,Any city or county which requires a- O
•
permit to construct, alter, improve, demolish, or repair. any structure, prior to its issuance also •" '- AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/ - '
i Division *3 of the Business and Professions Code, or that. he is exempt therefrom„ and the basis
/or •the •alleged exemption. Any violation o/ -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 (5500). • ,;. - - ' -
Plan Chk. Bal. Iiu
•?. ❑ I, as owner of the property, or my employees with wages as their sole compensation, will Y+f7a1.97 ; •
do the. work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and c , .•
:. Pro/essions Cotle: -The Contractor's License Law does not apply, to an owner o/ property who COf1S.t.
- R5. 50
Vii• 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 building _ - - q _.O
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.) EIBCtrICal _ 1i-
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing r -
strugt the projecC' (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 /or S.M.I. `
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ,
'Grading
01 am exempt under Sec. B. &'P.C. for this reason -
Driveway Enc. '
< Date T Fr?.6wner. t'/ ^"1' Infrastructure f A
WORKERS' COMPENSATION DECLARATION .. e
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.)
Policy No. Company'
❑ Copy is filed with the city. O Certified copy is hereby furnished.
- TOTAL
3.31
CERTIFICATE OF EXEMPTION FROMREMARKS
- - 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 the work for which this permit is issued, I shall not 'i'•?'avczsr-acs i9t[e3 'cv`r
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: Il, • alter making this Certificate of Exemption you ' should become—. ,'ZONE: BY:
subject to the Workers' Compensation provisions of the' Labor Code, you•must. forthwith 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.lhe 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 incorrect. 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. a Validated by:
Signature of applicant Date
Mailing Address - 'Validation:
City, State, Zip
1 - r_ •. ,. -• z -z Y. "'i J 3' + a! y:, -l. . J F 2 3 •
-t r • 3 ^a a .'1 t n f, i y...t ♦- Y. i Y '- ' * .r i:.>
t. t :G: :J' ! .h r.`PT,. a , .,1 . ;. L-_.11 .4•x'• .) .'L t- tiar 7° "'yr ... moo. .•'.r _.'L i. ., r..,l.? , °.+. ...Y•r• , Tom. .,R •art'.. • '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. S0. FT.
POR. SO. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® V4c
HOUSE SEWER
FRAMING q(
FINAL INSP. (($ q (
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 F —Z5;,
f 4.ONDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
r
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. [
GAS (ROUGH) 46 G((cp
(UUU{
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. G l to
FRAMING q(
FINAL INSP. (($ q (
ROOFING
P [
l
Pmwy 4" l `o (
4 o
C
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
HING ( L O
MESH
INSULATION/SOUND _liL
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL