CGAR (9803-175)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes— Chaprer 9 (commencing with Section 7000) of Division 3 of the Business and
N co Professionals Code, and my License is in full force and effect.
C,) -License # Lic. Class Exp. Date
CWi .57 a 3'k ii9,8
O Z r- ,Date Signature of Contractor
(0 O r�
J U C:) OWNER -BUILDER DECLARATION
W WW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z_ ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
CL z WORKER'S COMPENSATION DECLARATION
O tr I hereby affirm under penalty of perjury one of the following declarations:
r H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of'the work for which this permit is issued.
Cal Q U VQ I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
liul
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
cD Z) STATE r
r d S rtiil s 2�J4) }►i;L+2
J
(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, d a gree that if I should become
subject to�thep`orkers' compensation PF&i ions�of Section 3700 of(ihhee Labor
Qr j
Code 4's all h' ith comply with those DProve Ions. J�
Vbate: � i Applicant �i/ Z { f �_A 4t_
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.
(.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 authori{ repr�sentatives of this City to enter upon
the above-mentioned property' for in �edfiioon purposes. l
„Si nature (Owner/Agent) ent) ? � ° 4 �s Date 6—
y
r'
9 g —ma
BUILDINGPERMIT PERMIT# °°NTR°`#
DATE A VALUATION.�� LOT TRACT
7001
JOB SITE r APN
ADDRESS 57-2i
OWNER CONTRACTOR/DESIGNER/ENGINEER
NIAI SKA L L QUASON BOB 1w1)WAVZDS CON' 1` Otll
57260 MEMON 74-920 F1E8-I*A D.RIVV,
LA, Q01 NTA CA 9225`=3 LA QU1NTA CA, 92251
E76()t775• /433 t",.IRR •:32!
USE OF PERMIT Q
1 0 S.V. GOLF CA11T GARACI r AUDI i RiN ®�I
t
0ARA rFr`CARP012,'k 180.40" ST.
�.� C�IJINTA
GITy 01::
.�S'.�'1AIIr"L'gi'k+;�4 COST OFC;ll� 511,4. 1UfTON 3,52,1.00
PF"UT E+`>1'',VI SIUM.MARY
PLiWt'HrCXM, iii 3.-00;�•4:'�-3t13 $40,91
(70_NS'rR4X'r10N FVV, 363 06
)R -EC `f2]CA!- I.T.E. 10I -.(M-120-000 t9.6t3
QST EJNiI fbit)'(°!'f rN FM R4SID 101-000,241-000
TOTAII PERMIT VMS 01T.'Now
Y .
RECEIPT I DATE I BY - I DATE FINALED
VIA(*
�0,vo
S' 2a<(1;
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
Set Backs Q
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings /
Ducts
Slab Grade
retro Air
Steel
Combustion Air
Roof Deck / -
0. K. to Wrap
Exhaust Fans
F.A.U.
Framing -/S'-
Compressor
Insulation .. ?,St3 _.7E.
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
— 6 -
Exterior Lath —4 -16 -
Drywall
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Find
Utility Notice (Perm)
COMMENTS:
-
Building
57466 Herftfll
Address
Owner
Rear Setback from Rear Prop. Line
Swrilse Cwparvy
Mailing
Estimated Valuation
Address
42-600 CWk St...
City
. '
Zip
Contractor
Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
-7—
No. 0766(
446
BUILDING: TYPE CONST. OCC: GRP.
A.P,,Number
Legal Description TrWt 25499.1
Project Description Phase 7H Platt MA
i Address sates
City Zip Tela "
State Lic. City
& Classif. 13.Q Lic. # 32$ Sq. Ft. M9 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City
rdz IP (State
-� Lic. #
LICENSED CONTRACTOR'S DECLARATION
+ 1 hereby a firm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3f the Business -arid Professions Code, and my license,is in full force and
effect. �. i n�.
I hereby affirm that I am exempt from the Conoactor's License Law for the following
reason: (Sec. 7031.5,Susiness 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 rile 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 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ 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.)
❑ 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.)
Policy No. Company
❑ Copy 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 the work for which this permit is issued, I shalt not
ploy 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
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.)
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
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Estimated Valuation
$2I4,923
PERMIT
INSPECTOR
AMOUNT
Plan Chk. Dep.
Validated by:
Plan Chk. Bal.
Validation:
838.5#3
Const.
1 t142.fln
Mech.
73.00.
Electrical
132,H
Plumbing
168.50
S.M.I.
15.,05
Grading
Driveway Enc.
rifrastru tur4.835.77
2 89
Infra Due
TOTAL
4,687.73
4(r,777 I,
REMARKS
f�
1p F _ .147.71
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 4/23/90ermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. Fr. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
I 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
�AS (ROUGHQ'7T--Ig c1
�
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
I IKITCHEN 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 ® 1 Vi c
SEWAGE DISPOSAL
Ole TO Q c, Jq Fj ��
(�C `
SO.FT.GAR ® 3/ic
HOUSE SEWER
VENTILATION
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 PLU I C/
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER�i K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
`
FOUND. REINF.5 S- r?o v J
�AS (ROUGHQ'7T--Ig c1
�
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.
AL INSP. 7
ZAAMING a I �� O
FINAL INSP.
rbGR OFING
Ole TO Q c, Jq Fj ��
(�C `
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
//��
0/ SULATION/SOUNDq�/-jv
K
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL