PLBG (9702-013)79615 Marigold Lane
9702-013
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 .
2 I 3INIi C-36 XV97
ate Signature of Contractor ✓ <--° V ` {w
i
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.
(d) I have and will maintain workers' compensation insurance, as required by
S ciion 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 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' compensation laws of California, and agree that if I, should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Cdie, I shall forthwith comply with those provisions.
t/6ate: Applicant u 1/1
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.
ignature (Owner/Agent) 44 11— Date
PERMIT k CONTROL #
BUILDING PERMIT
4676
VALUATION LOT TRACT
DATE 2/097
JOB SITE
ADDRESS 79-615 MARIGOLD drAtV.i'.,
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MANIR CLAISMALI:.
VALLEY PLILAIMING
i..96I S tvttl3r'l6:•+OLD Qq
46780 C;I.TN1,ON
I.A QX ;M A CIA 92251
IC`t1?'ID CA. 921,01
((+i 31Z 17.3 V C.;131N 101
USE OF PERMIT
Y't.i.t 11#
A.'A 'l:AT4(-W Lt0:0 011.S
.'° p ' ,r . - 4:. .'• . . . ' a' . : .12.1Z . tt,✓j
.A ii: 'r
gp y6 yy 1 yy r p yyqq,dp[`
II O.•C IYi d.•Y .b.i'i:CJ S1U 7,l f tti. 1
{#3.9_0()0_4f$212.5rr
s
50
LESS PREIPAID FEES
p
i°(.A"S iu, Prit var vans nor. mow
$22-50
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
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
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
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
61111Y
Final
COMMENTS:
Final -3.
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)
414.
Tit
P.O. BOX 1504 No 064.70 _
Building 78-105 CALLE ESTADO
Address 79--615 Marigold Lane LA QUINTA, CALIFORNIA 92253
Owner .. .... i .
La
i-ataso> e8 BUILDING: TYPE CONST. OCC: GRP.
Mailing'
Address 43-375 Washington 5t.Tired 22332 Phase III
A'P.'Number
City Zip ITel-
Palm
-Desert 92260 .34, 7-7541, Legal Description
Contractor Plem 5A Let .64
Williamd bev. Corp. Project Description
Address ..
Same
City Zip
State Ljc. 4r3919
& Classif.
Arch., Engr.; `
Designer
Address-
Gll
Lic•# •. .. a l . ,2,1.34
Sq.'Ft.No- • - No. Dw.
Size • • • Stories • Units
Tel.
New ❑
,Add ❑ Alter ❑ 'Repair ❑ Demolition ❑
City
Zip
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 license is in full force and
,
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,Buskiess 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).
' '.0 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 offered for sale. (Sec. 7044, Suisness 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 bmld or improve for the.purpose of sale.) ..
Estimated Valuation '
$113,413
-i- - AMOUNT
--• . •PERMIT , -
-- -
`
Plan Chk kDep. .. • - '., •,' b. ;
,
Plan Chk. Bal. _ • .1k \ ' "57 + . - `•
Const.' _ 688050
Mech. . .5 '
i _• C _
Electrical 120.17
•
Plumbing- • •,y 138.50 -
_ 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
S.M.I. --7.98
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.) • -
f ❑ I am exempt under Sec B. & P.C. for this reason
Grading '
Driveway Enc.
"
. Date Owner
Infrastructure 2,551..79.
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
❑ Copy is filed.with the city. . ❑ Certified copy is hereby furnished:
, 1
- 4
TOTAL $4,130.76
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKSe"f (_',}„4t-•r , » :'
11,4%4r l ,. f-d1tY±t_ .L •rl-,re-, i V !
(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
employ any person in any manner so as to become subject to the Workers' Compensation '
Laws of California -
..
Date_______' Owner
•NOTICE TO APPLICANT: N, after making this CertificateofExemption you should become _
•subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Comply with such provisions or the permit shall be deemed revoked._. '.. - -
•• ZONE: `BY:
Minimum Setback Distances'.
Front Setback from Center; Line
Rear Setback from Rear Prop: Line
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. (Seo. 3097, Civil code.)
Side Street Setback from Center Line '
_%.
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE. I CTOR
10/3/89 ”
Issued by: Date Permit'
Validated by: `
- 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 buildings
construction, and hereby authorize representatives -of .this city to enter the •above.
mentioned property for inspection purposes. ,
Signature of applicant Date
Mailing Address
'
+ValldatlOn:
City,. State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
OUGH PLUMB. or BONDING
HEATING (ROUGH)
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL SQ. FT.
DUCT WORK
ROCK STORAGE
FOUND. REINF. oO (��
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) 6//�� TEMP. POLE
/ Z
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. SQ. FT. ®
WATER SYSTEM
FINAL INSP. 6 Q=
FINAL INSP. $
GRADING
cu. yd.
plus x$
WALL SQ. FT.
LUMBER GR.
DRINKING FOUNTAIN.
SQ FT ®
J / / Q 7
G
� V
/
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FENCE FINAL
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
VII ?w
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADEfQ 'f, v�®
OUGH PLUMB. or BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. oO (��
GAS (ROUGH) J 1
( / [ METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
REINF. STEEL
GAS (FINAL) 6//�� TEMP. POLE
/ Z
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. 6 Q=
FINAL INSP. $
GRADING
cu. yd.
plus x$
=$
LUMBER GR.
FRAMING ` 2l d
ROOFING Z /�J s`��
J / / Q 7
G
� V
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING J 1 �y (��
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL