CGAR (9807-089)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
694857 1/3 i /00
v ate F.
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). ,, +
O I am exempt under Section B&P.C. for this reason 1i
Date fSignature of Owner t'
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 forrby Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Se( ) I have and will maintain workers' compensation insurance, as required by
tion 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.
c ,• nv K 11 'war. 9-N�t o 7
(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 prfovl Ion.�of Section 3700 of the Labor
Code, I hall forthwith comply with/hose visions.
,+Date:��� Applicant tli:�..�_.�
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
theAbove-mentioned proprtr�r
nspegtion purp"ose's.
,Signature (Owner/Agent
Date`
PERMIT# ! CONTROL#,. ,.
BUILDING PERMIT tI
DATE VALUATION ��55Z.I�.I� LOT TRACT,
',802
JOB SITE
ADDRESS 57-18I Ii1friRION
APN
OWNER
CONTRACTOR DESIGNER / ENGINEER
'11yy,
l.i,
`TO" N
7iL%inR�ti'G}y.w'J�� '
57181 iitl.4d;O14
!9-920:FIES'i'E�DRIVE
.I.A.QUIN'I:A CA 99253
LA.QUINT.,A. 1 SY1253
(76Q)775-7933 0131,11 3212
USE OF PERMIT
61k,,jjJJ
IN 5+.1' CO.LF CAAet' GARAGE ADDITION
PM
V
' 0i't1Rf0\7lS+l.rAR,PORI 180.00 171
OF LIN Q1114�
�l
' �7'.Ky wil9�.l��Q.'.a ii ti�..'�+�R li'ii r.-'sJ�i��N. air a..�it�.6RJl. �T
�;�,K�J.�•W
PE.AxW V19X, :tiUMOVI'ARY
P ;,AfY 64ECK-17M S410.95
;p
13t 1XIMiw.r1L FEE' 101- '000-420
:seROW; 'NIOTfON' 11f 3aNJ 6113 .101 _00 -VII -000 �,SC
a
5011 -TMA C(_)Nq ltl..fC110NP4;f1,N CIR17,CK
T,12:x 05
'Ess • P;I "C'�-P.mo F EE
' ' 70TA:I:, PI?',.Il�INIff F €IM .{?ii'E`.tNOW
X32 .I1:3
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR „
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVA S
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 —
Insulation
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath zy
09
Final
Final .� —Y -;:J-.,
BLOCKWALL'APkOVALS
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:
Bin !i
City -of, U Qdihta
�-Z
i� ... . .....
Building.81 Safety Division
P.O-Box X1 504
787495,Calle.,T amOico
...........
Permit...
La a,
Quint CRA -92253 -
. . . .............
..........
Building Permit A litati6h a' d. Tracking' Sheet
M PP..
Project Address. 57 *A
Owner'sNirne.
I
?Number:
Ad&ess: --
7--(811 a',A.
Leal Descrption-
CityST, Zip:
C
-Telphone:Cntrac,or:
Address: 'q Zd
boya,
Project' Descriptio
4"" .
cit� .ST. Zip:
iel phone--, .153fk
e
. .. ... ..........
. .........
Sta teiic'm 9
.,City Lic.
P.
F'Aicli.*. Ener Designer."
s 2_5
Address: (4 4
XL J INT
�City. ST. Zip.
_ip T
B.D.
Telephone:
T�e
.. .. ..... ...
..........
Construction Type: Occupancy:
State Lic. 9:
Project type (cirde one): New Add'n Alter Repair Demo
Ame of �oniact Person:
N .
Sq. Ft.:
Stories:
�U n -its:.:
,
TPIPnhnne 4 of Contact Person:
Estimated Value of Project:
ac
'B
1........ ... ......... . .................. ...... .
CONSTRUCTION ESTIMATE
N0. ELECTRICAL FEES
NO PLUMBING FEES
IST F!
2ND FL
POR
GAR
SAR PjQ
WALL
ESTIMATED CONSTRUCTION
S„ =7
UNITS
ROUGH PLUMB,
SO. FT •fj
YARD SPKLR SYSTENN
SG. E MOBILEHOME SVC
BAP SINK
SO FT. ,q POWER OUTLET
ROOF DRAINS
FT ,Z
DRAINAGE PIPING I
SC FT n
DRINKING FOUNTAIN
50 rT. a
URINAL
VALUATION S
WATER PIPING
NOTE: Not l0 me -.sea as prooeny :as +afuahon
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM VAN EVARCOOL HOOD
SIGN
WASHER(AUTOMOISHI
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
. $
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
I KITCHEN SINK
ABSORPTION SYSTEM B.T.0
TEMP USE PERMIT SVC
- WATER CLOSET
COMPRESSOR HP
POLE. TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
I SHOWER.
BOILER B.T.U.
SO. FT. r c
BATH TUB
SO. FT. 'N c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SU. FT. RESID 0 1 w c
SEWAGE DISPOSAL
SO.FT.GAR @ xac
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 8 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
CIL yd,
= plus Xi
. $
LUMBER GR., t
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARK&
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONSOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTORS SI INATUREMNTIALS
GARDEN WALL FINAL
JUL-29-98 W�EE� 4' I8 Pt:J P:fCiIAFUHGROUP s r � FH° i•�v: b19 r?6 51I I P. 1
,V
-juiy 1d, 1998
Mr, 801 Coniey
57-181 Merion
La Quinta,. CA 92253
KE; ArchiteCtural Chanoe Reau
Dear fir. ConiPv,
ne C-6nd(T'+iniI!m Arrh,F,,,.-
�i«cc Pias rCveweo your request for the addition Of
�� ��^ ..U� �w+n�' i ne'committee is pleased to inform you
th.t if tiar vn a
�31- M—uesr v" h the following conditions: ..
I. Nciiv sir garage door MUST match original existing facing of main
garage door. - r
4. ivo:new landscaping lights to be installed as'none aria, chnwn on mane
(The Condominium Guidelines state that exterior Iinhfinn nn ncau, .�:..�.
additions is not to exceed what was orioinauv indauArl i �'
Niease have your contractor contact meat ('7601 776-51 nf) whon. wnnrio, le
that we may Coordinate an inspection
F+c.�.�i011 and the •relPacP of vni it
Sincerely, _
For the Condominium Architectural commit
tee
John J. Monahan
Association ManaQer
CC, Board of Directors '
Unit'File
e
Building S7-181 Hergon•
Address
Owner
Sunrise Com
Address 42-600 Cook Street . Suite 240
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.
Palm. Desert • 92260 1 568-2828
Contractor
. . . National Mortgage Land
Address.
Same
City lZip Tel. "
State Lic. I City
& Classif. 288130 Lic. # 398
Arch., Engr.,
Designer
Address Tel.
City I Zip I 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
effect:
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,Business 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 (S500).
❑ 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, Bussness 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 safe. ff, however, the building
or improvement is sold within one year of completion, the owner -budder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to com
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.)
❑ 1 am exempt under Sec B. & 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, or a certified copy thereof. (Sec. 3800, Labor Code.J
Policy No Company
❑ 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, 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. ff, 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, Cfvfl 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 certity 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. 07249
BUILDING: TYPE CONST: OCC: GRP.-
A.P. Number PGA
Legal Description Tract 24801
Project Description Phase S`4 - Plan U3 '
Sq. Ft. 2899 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $234,923
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.•
Const.
,0 •U
Mech.
Electrical
[.!
Plumbing
lti�5t
S.M.I.
2:Tr Ci
Grading
Driveway Enc.
Infrastructure
Wess Malt2,417.89
Intra Due
��ill.UV
TOTAL
'6--, G r
REMARKS
f,#4c*4-f., ,_14fX_1 V;0`4,44 -7 c7
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 2!/2 f Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
/
SLAB GRADE (�
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF. L/•3 /�
[ v v
kGAS (ROUGH) �2
!/
DRAINAGE PIPING
CAR P. SQ. FT.
OTHER APPJEQUIP.
REINF. STEEL
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
^
Aj f
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
MESH
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
ROUND PLUMBING jy- 1
UNDERGROUND
A.C. UNIT
COLL. AREA
/
SLAB GRADE (�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR SEPT
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. L/•3 /�
[ v v
kGAS (ROUGH) �2
!/
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.
AL INSP./Q
FRAMING ��
FINAL INSP.
ROOFING
^
Aj f
( _ GYj
C�
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
CTHING ? `/L - U
MESH
tINSULATIONISOUN D`r1
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL