RR (05-1891)77123 Calle Mazatlan
05-189
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,.CALIFORNIA 92253
Tiht 4.4 Qu&k
Application Number:
_ 05-00001891 .:
Property Address:
77123 CALLE MAZATLAN
APN:
.658-230-011- -, -
Application description:
RE -ROOF
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:'
- 6505
• Applicant:
Architect or Engine
BUILDING & SAFETY. DEPARTMENT
BUILDING PERMIT
Owner:
STEINBOCK PHILLIP M
125 CALLECITA
LOS GATOS, CA 90532
n
MAY 2 O Q S Contractor:
WESTERN PACIFIC ROOFING CORP
CITY ® ` QUINTA 3 46 2 . LA CAMPANA WAY
FIINAPIC_DEPT. PALM SPRINGS, CA 92262
(760)000-0000
Lic. No.: 235717
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
5/19/05
l
i
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 Name:
Lender's Address: v 1A
LQPER111IT
of La Qwnta, 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 '
o court td ter upon bove-mentioned property f 'ns ctl purpo
ate: Signature (Applicant or. Ag
------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
- WORKER'S COMPENSATION DECLARATION
I hereby affirm under, penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with -
I hereby affirm under penalty of perjury one of the following declarations: ..'
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C39//,License No.: 235717
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
/
ate: o t, ntractor:
.)
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
1 /
.
- /K
Code, for the performance of the work for which this permit is issued. My workers' compensation
` OWNER -BUILDER DECLARATION
insurance carrier and policy number are: ,
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
•. Carrier STATE FUND Policy Number 0457624-2005 ,
following reason (Sec. 7031.5; Business and Professions'Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ'any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the.Contractor!s State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Lava (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
3700 dppli'caqt:f e Labor Code, I shal forthwith compllyy//y%ith//t/pse provisions. ,
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: a r
`^G/ any
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
t
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that.the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). -
APPLICANT ACKNOWLEDGEMENT .
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of -
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
( 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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 Name:
Lender's Address: v 1A
LQPER111IT
of La Qwnta, 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 '
o court td ter upon bove-mentioned property f 'ns ctl purpo
ate: Signature (Applicant or. Ag
Application Number . . . . .05-00001891..
Permit RE -ROOF
Additional desc ._
Permit Fee. 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 11/15/05
Qty Unit Charge "Per
Extension'
i
BASE FEE
30.00
-----Special Notes and Comments
RE -ROOF WITH POLYURETHANE FOAM COATING
SYSTEM
Fee summary Charged Paid
Credited
Due
----------
" Permit Fee.Total- 30:00
.00
.00
30.00
Plan Check Total .00
.00
.00
.00 ,
Grand Total 30.00
.00
.00
30'.00
LQPERMIT. ..
.
P.O. BOX 1504 No. 05,848
Building 78-105 CALLE ESTADO
Address 77-123 OALLE NAUTTUN LA QUINTA, CALIFORNIA 92253
Owner
Address SAM
City Zip Tel.
LA Q%MT1 42253
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 heresy affirm that 1 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 f II force and
v
effecty. ?
_SIGNATURE r DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8ushess and Protessions Code: Any city or county which requires a
permit to construct, alter, improve, demafsh, or repair any structure, prior to its issuance also
requires Ne, applicant for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions trade, 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 chd penalty of not more Nan five hundred dollars (S500).
❑ 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, Buisness and
Professions Code. The Contactors License taw 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 iinprovements are not bdended or offered for sale. If, however, the building
of improvement is sod wVA. one year of completion, the owner -builder will have the burden
of proving that he ufid not bold of improve for the purpose of 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 cmtractor(s) foensedpursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec a, & 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, ora certified copy thereof. {Sec..3800;'Labor Code.)
Policy No Company •'✓ r I r
❑ Copy is filed with the city- ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conpNrted ff the permit is for one hundred dollars • ($100) valuation
or less.)
I certify that in the performance of 0V work for which this permit is issued, 1 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: O, after nrLUrg this Certificate of Exemption you should become
subject to the Hbrkers' Compensation provisions of the labor Code, you must forthwith
comply with such provisions or this permit shag 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 property filled out, signed and validated; and is subject to
expiration if work thereunder is suspended for 180 days. '
I certity that I have read this application and state that the above information iscorrect.
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 SANTA ROSA CM
Legal Description w
Project Description SPA
ROIL EY POOLS
Address
Sq. Ft. No.
Size---- Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
74-170 DESERT STAR
City
Zip
Tel.:
P.D.
92260
346—t689-,
.
State Lic.
Estimated. Valuation a Ai}O .
City
Classif.
C53 320-537
Lic. # 521
Arch.; Engr.,
Plan Chk. Bal.
Designer
28.Oi3
Mech.
.41 -
*'Address'•
Electrical
30..00
'Address -
27.00
I Tel.
City I
Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 heresy affirm that 1 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 f II force and
v
effecty. ?
_SIGNATURE r DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8ushess and Protessions Code: Any city or county which requires a
permit to construct, alter, improve, demafsh, or repair any structure, prior to its issuance also
requires Ne, applicant for such permit to Me a signed statement that he is licensed pursuant to
the provisions of the Contractors License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions trade, 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 chd penalty of not more Nan five hundred dollars (S500).
❑ 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, Buisness and
Professions Code. The Contactors License taw 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 iinprovements are not bdended or offered for sale. If, however, the building
of improvement is sod wVA. one year of completion, the owner -builder will have the burden
of proving that he ufid not bold of improve for the purpose of 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 cmtractor(s) foensedpursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec a, & 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, ora certified copy thereof. {Sec..3800;'Labor Code.)
Policy No Company •'✓ r I r
❑ Copy is filed with the city- ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be conpNrted ff the permit is for one hundred dollars • ($100) valuation
or less.)
I certify that in the performance of 0V work for which this permit is issued, 1 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: O, after nrLUrg this Certificate of Exemption you should become
subject to the Hbrkers' Compensation provisions of the labor Code, you must forthwith
comply with such provisions or this permit shag 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 property filled out, signed and validated; and is subject to
expiration if work thereunder is suspended for 180 days. '
I certity that I have read this application and state that the above information iscorrect.
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 SANTA ROSA CM
Legal Description w
Project Description SPA
REMARKS y Y y ryy } {
B.' t`A' 16-1 -85299A6
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,.7/89 Permit
Validated by:
Validatiot
Sq. Ft. No.
Size---- Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑
Repair. ❑ Demolition ❑
Estimated. Valuation a Ai}O .
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
28.Oi3
Mech.
24.0T_
Electrical
30..00
Plumbing
27.00
S.M.I.
..77
Grading
Driveway Enc.
Infrastructure
y-.
TOTAL
tai `'f` /y
REMARKS y Y y ryy } {
B.' t`A' 16-1 -85299A6
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,.7/89 Permit
Validated by:
Validatiot
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL Sp. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. I SO. FT. ®
FINAL INSP.
WALL Sp. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
Sp FT ®
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
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.
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 ® 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 APPJEOUIP.
REIN F. 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
O
oll
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
'
s • J , r
TA
-414
P.O. BOX 1504 N Q.003734
Building78-105 CALLE ESTADO
Address 7 '!-123•Mazo-t a_ LA,QUINTA,CALIFORNIA:92253
Owner
La Quinta k7oijit. Venture
Mailing .. - BUILDING TYPE CONST OCC: GRP: -
Address Q €3 BOX 780 Santa Rosa,. Lygv 3,.
City Zip Tel.
Laquint %..-: .92253. - 564-:1315 •_ Legal Description
Contractor Projecc t Description P2 mina Capa
... .. "
Address .. ,
City.
1L.:.. Zip .. .. .. Tela
La 'minta 92253 ,56A 244
State Lic. City
& Classif._ Lic: # Sq. -Ft. ' 2 No. No. Dw.
... Size Stories .
Arch.; Engr..,.. _ :. .
Designer;_New ❑ Add ❑ Alter ❑ . Repair ❑ •Demolition p
Address ....eti . Tel.
t "
City _ Zip State
.. Lic: #
,.,A LICENSED CONTRACTOR'S DECLARATION v
I herebyy aft m that I wn licensed under provisions of Chapter 9 (commencing with}Section
7000) ofspivision 3 of the Business and Professions Code, and my license is-imfull*f orce and—
effect
_ ... ..
SIGNATURE • "' ' ", B .f - DATE _
OWNER -BUILDER DECLARATION i
I hereby affimm that I am exempt from the Contractors License Law for the following Estimated Valuation
reason:. (Sec. 7031. S,Business and Professions Code: Any city or county which requires:a
X1:26. 397 _
Permit to:.construct, alter, improve, demolish, or repair anyrstructure, prior to its issuance also 'AMOUNT' "
requires the applicant for such permit to lila a signed- statement that he is.licensed pursuant to ... PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with:Section 7000) ofm• `
•' Division 3 of the Business and Professions Code, or'that. he is exempt therefrom, and the basis w - - - - - -
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 live hundred dollars (S500):
Plan Chk. Bal..409.42,
AA 0n µt 2
,- D I, as owner of. the. property, or my employees -with wages as their sole compensation, will • - • • ` 2 V 9 n'32. '
do the work, and the structure is not intended -or offered for sale. (Sec. 7044, Bulsness and
Professions Code: The Contractor's License Law does noh apply to, an 'owner of. property_ who COnSt. •
builds. or improves thereon and who does such work himself or throughhis own employees,. '. Mach., "'✓ ' '
provided that' such., improvements are, not intended or offered for sale. 'if, however,. the building w
or improvement is sold within one year of completion, the owner -builder will have the. burden Electrical n `
of proving that he did not build or improve for the purpose of sale.) • -7 3.09
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
;= w
Lr. struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law -"
_- 00
does not apply to an owner of property who builds or improves thereon, and who contracts for . S.W. - _ -P. 8 Ft
• "
such -projects with a contractor(s) licensed pursuant to -the Contractor's License Law.)
-•
Grading.
O 1 am exempt under Sec.. B. 8•P.C. for this reason -
Driveway Enc.
Date Owner Infrastructure. 2.843.94
WORKERS' COMPENSATION DECLARATION
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 ✓ •,.. a: -. Y r
❑ Copy is filed with the city. , p Certified copy is hereby furnished. .
TOTAL '
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE. !
(This section need not be completed if the permit is for .one hundred dollars ($100) valuation
or less.).__^• Pi-w
I certify that in the performance of thg I/ work for which this permit is issued; I shall not a w - 6y.a11'"-3.14':
employ any person in any manner so -as to become subject to the Workers' Compensationr
Laws of California. 4 :d kH i R11 AL It 3V68.81
Date: Owner"
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you- should become ' ZO•NE: .BY:
subject 'lo the "Worker"§" 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 _ • f
.Lender's Address t
This is a building'permit when properly filled out, signed' and validated, and Is subject'lo FINAL,DATE "' INSPECTOR `
expiration it work thereunder is suspended for 180 days. - .. - .__:_ _ : • --3/21/89
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 -of .this city to enter the above-.: ,
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation: ;
City, State, -Zip S .
HARD COPY
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
(ROUGH x
!
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPIEQUIP.
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.
SQ. FT. ® c
BATH TUB
SQ. 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
REMARKS:
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO F7
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.
(ROUGH x
!
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
REINF. STEEL
AS FINAL) -27-V
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
A INSPECTION r
!!!///
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Atl.dchment 0
PREPARED FOR:
Fo rm 2,
Glenn Bradley Enger, A..I.A,
(Revised
3/34)
73-960 El Paseo, Suite 5
Climate Zones 2, ,.G, and
G-15
Palm Desert, California 92260
COMPL;ANCE CHECKLIST P-2 ANACAPA by LaQuinta Joint Venture
F or Low -Rise Residential Buildings
(except hotels and motels)
Step 1: .Enter on the form the values foe'cach measure from,your
building plan
and specifications sheet,.
Step 2: Enter points on this page while working' through
the point system
Buildino Shell
Mee.sure
Points
4Total Floor Area
1330 ft
1. Slab -on -Ground; Perimeter. Q Z ft. , Depth- 4r ..
2. 'Raised Floor "n -Value, ,R_
, , , , , . , R_ Q
-4
3. Ceiling'Insulation or Construction Assembly , , , ,
, , , , , , R-':E',f
Attic, Percent of Roof. Over Conditioned Space to 0 0
4. Wall In"sula"tion or Construction
. . . . 17 30 ft.-
_0
-
Assembly.
R- i
Glazing; Total Floor Area Single Double.
Triple
5, tlorth- Facing. . O ft
t.
st-Facing 1•q o ft2 2A f
1. SoiZ
South -Facing. 3.Ci_F ft2 f,2
ft2.
2
8, West -Facing . . . S.3 ft2 ft2
9. Skylight.
ftZ
ft,2
O
-I(o
O. q` ft ft
ft
-
10.' Shading Coefficient
(excluding overhang)
a. East . . .. . . . ... 0405 SC
b.. South.
J_
. . . .' . . . . . . D• GS SC
e.- West o. SC .
d. North. %SC .
. . . . . . . . . . .
. . _ . . . . . .
- 2
-26
. . . ... .
e. Skyi i gh.t D.i0S SC .
Horizontal South Overhang Length,' 7- ft
. . . . . . . . . . . "
0
- 2
12. .Movable Insulation, A Floor Area. N e
13. Infiltration "ignt)
G
(indicate Standard, Na_dium ur
14, Thermal Mass
Exterior Udall "Thermal. Mass,
Area,•Heat:Capacity, R -Value . . . . , ,
ft2, HC, R -
Interior Thermal Plass
'Area, Heat Capacity, R -Value . . . . . 9W ft2,I hC, R- a 3 + 20
HVAC System—
r OAI.a
-
L, 1,730
15. Gas Furnace without Refrigeration• Cooling
(Seasonal Efficiency)
16. Heat Pump (Energy Efficiency Rao)
N/ SE
0
ti
17. Gas Furnace with Refrigeration Cooling
NA EER
--
— —
Seasonal Efficiency and Seasonal
Energy Efficiency Ratio.. .
18. Active Solar (Net.Solar Fraction, ",•) ,
SE q 5 SErR
-=-
+I2-
, , ,
19. Zonally Controlled Electric
T-
-
Resistance Space Heating , . , , , , ,
(Yes/No} nl0
O
Domestic Water Heating**
20. Solar With' Gas Backup :(,Net Solar Fraction, ;) ", ,
NIP, •NSF
21. Other'Water Heating (Describe type)
0,
Point Svstem Ccmoliance Total. . . . . . . .
. . . . .
•(,heel ust lteq not a point system measure.
."Attach documentation for efficiencies and NSF.
PREPARED BY:
Joseph N. Cicchini, Civil Engineer, Inc.
44267 Monterey Avenue, Suite B
Palm Desert; California 92260 (619)-341-2273