BLDG (9607-068)50172 Calle Maria
9607-068
12324
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
..
23i 7 f:
Date 7 a Signature of Contractor
OWNER -BUILDER DECLARATION',-'
I hereby ffirm under penalty of perjury that I am exempt from the. Contractor's
License Law for the following reason: r
( ) 1, 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.offBred 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). ' r
O . f am exempt under Section . B&P.C. for this reason-
Date
easonDate Signature of Owner
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of .perjury one of the following declarations:
O 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.:
S ) I have and will maintain workers' compensation insurance, as requiredby '
Section 3700 of the Labor Code,,for the periormance of the work for_which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.. .
(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' compensatiori lawsof 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:
rovisions:Date: '7- 2'- 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 T'
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 age Iees'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.
f' i
Si nature (Owner/Agent)Y "' r-` ' X-17l / is Date
BUILDING PERMIT.- PERMIT# °°NTR°`#
607- -3738
DATE VALUATION LOT TRACT .
71TV96. Vit. t 2.00 .JOB
SITE
C
ADDRESS -3C :a2.iKu i IA l fl "al.;'G TE)
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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i' N•; A '*..i,.dry.SAC.r iV '` :, JA'
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5sAG'r CALLF Q11.}1'..i' LA '
M62 LA. C:.AkPEyNA141PLY
LA. Qf-lf't I A CA 922.53
PA1.W-T SPRfJNGS CA 9226_0
:. 3240'22 Gl3I t-
USE OF PERMIT
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$130:00
.$0.00
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4U4-2 3
996'
y
RECEIPT
AJBY
DATE FINALED
INSPECTOR
9
— - i - - -- ------ — --- — — -
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
O.K 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 APPROV LS
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:
�1
J
P.O. BOX 1504
•Building 50-172 Calle Maria. 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Fox
Mailing
Address $rmAe
City • zip. JTel.
La Oninta, ic 92253 564--0245
Contractor
Brooks Rooflngto.
Address ; t
.P. O. - Bam 3722. /
City. Zip Tel.:
4-31M, Desert,, :% 92261 558"=923.2
'State, l Ic. City
a'& Classif. - C-39'„483892 Lia !___, 11`;
Arch:,-Engr., r `
Desioner,i' y
j ,.
;`Address ; - Tel.
-`Cjty .r Zip State
J. Lic. #
" LICENSED CONTRACTOR'S DECLARATION
r .I hereb afhrrp that I am licensed under provisions of Chapter 9 (commencing with Section
'7000) of ivis,19 33,off the Business anrd,Professions Code, and my licen a is in full (ocryCe•and
effect. l a ',2K t
DATE
OWNER -BUILDER DECLARATION t
' •: -;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, I 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 Caw, Chapter 9 (commencing with Section 7000) of
Division 3 of -the Business and Professions Code, or that. he is exempt therefrom, and the basis
F 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 build or improve for 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 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.) -
6'1 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.)
PolicyV 0. Company
RrCopy 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 ($100) valuation
or less.)
I certify that in the performance of th(; work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code,, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending -agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to.
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
N0. 1.23
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description "
Project Description$ Remo$
Sq. Ft. No.
Stories
New ❑ Add 0— Alter ❑
NO Dw1 rF
Units J
Repair,❑ Demolition ❑
1
TOTAL -;,3 0. 0 0
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
'Rear Setback from Rear Prop. Line
Side Street Setback from Center Line } i
.SI aro fnm D _
t~
FINAL DATE PE41`1
Issued by:t¢P r
Validated by: y CII F
t {
Validation:
Estimated Valuation 02,200,00
PERMIT
"AMOUNT
Plan Chk. Dep.
;• ,
Plan Chk. Bal.
'Const.
30..00
Mech.
Electrical
Plumbing
.S. M. 1.
rr-
Grading
Driveway Enc.
Infrastructure
TOTAL -;,3 0. 0 0
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
'Rear Setback from Rear Prop. Line
Side Street Setback from Center Line } i
.SI aro fnm D _
t~
FINAL DATE PE41`1
Issued by:t¢P r
Validated by: y CII F
t {
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
r+ ri
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
WALL SO. FT. ®
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 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.
ROOFINGL G�3
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