BLCK (04-3318)P.O. BOX 1504• Y 4 4 :�r��
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number- VY - 33 / 8 Date:
Applicant:
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Applicant's Mailing Address:
sa37s RVE/V,,PA- /✓AiV1ail0
Architect or Engineer:
A10P4 a
Architect or Engineer's Address:
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BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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 Class License No.
Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following.reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law.(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 any applicant for a permit subjects
the pplicant to a civil penalty of not more than five hundred dollars ($500).):
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,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the 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 or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds.or improves thereon, and who contracts for the projects witha contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this r Cason_
Date 4
Ell, WORKERS' CWENSATION 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.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier / Policy Number
je 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 Califomia, 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.
(L/
Date ! � Applicant
WARNING: FAILURE TO SECURE WORKERS' CQWPENSATION COVERAGE IS UNLA FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm ndep r 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
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, 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 of this county to ter upon the abo tioned property for inspection purposes.
Date Signature (Applicant or Agent):
I
P.O. BOX 1504 t APPLICATION ONLY
7&105 CALLE ESTADO
Address Z"�% S ��' �, LA QUINTA. CALIFORNIA 92253
Owner.._
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Mailing BUILDING:=TYPE • CONST - -• •OCC:GRP .'=
-
Address3lQ W� ti �a�2[ �� -�%
.: A.P. Numbe _
City _ Zip ITel. ; f
^ G. D� 2� - , Legal.Descriptio
C� n
Contractor ' Project Description
_ Address
City Zip _ Tel.. -
State Lic. City _
& Classif. Lic. # Sq. Ft.J`%�¢ No. No. Dw.
Arch., Engr. Size C? Stories Units - -
Y
'Designer r
New ❑ Add ❑
.. Alter, ❑ Repair.❑ _ .. `Demolition,.❑ ,
Address
Tel.
City
Zip
State -
_ .. _....
._. ......._ .. ,_
• �t
o /
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I here?yaffl lm iia licensed under provisions of Chapter 9 (commencing with Section
70pp) df Division of Business and Professions Code, and my license Is '? full force and
- - -
� ec
S OP7 —bATE
OWNER -BUILDER DECLARATION
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Suslness and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, demolish, or repair any structure, -prior to its issuance afro
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
- -- --PERMIT
- -- - - -- --- AMOUNT -
the provisions of the Contractor's License Law, Chapter 9 (commencing, with Section 7000) of
Divislori 3 of the Business and Professions Coft 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
Plan.Chk. Dep.
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
Plan Chk. Bal.
i
do the work, and the structure is not intended or offered for sale. (Seca 7044, Buisness and
Const.
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,
Mach. --
- - -
provided that such improvements are not in or offered for sale. If, however, the building
- - -'
orimprovement Is sold within one year of completion, the owner -builder will have the burden
Electrical
i ••
of proving that he did not build or improve for the purpose. or sale.) _
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
l
does not apply to an owner of property-who,builds or Improves thereon, and who contracts for
S.M.L
_
- - -
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
1•
❑ I am exempt under Sec. B. & P.C. for this reason
-- Grading
_
Driveway Enc.
,
Date owner
Infrastructure-
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.
'
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.)
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: It, after making this Certificate of Exemption you should become
ZONE:
BY: I_ -
subject to the Workers' Compensation provisions or the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. k
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 per ,t is issued. (Sec. 3097, Civil code.)
Side Setback from Property Line
Lender's 'Name
/
Lender's Address
FINAL DATE
INSPECTOR
This is a building permit when properly filled ut, signed and alidated, 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.
'city_.an
Issued by:
Date Permit.
I'agree to comply with all unty ordinances and state laws relating to building
construction, and here?y authorize presentatives -of -this city to enter the above-.
mentioned property for tfspection p e' . i
Validated by:
Signature ofapplican
-Mailing Address '
Validation:
4
City, State, Zip
BUILDING DIVISION
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES^
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAO P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
I WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
IHOUSE SEWER
LATHING
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.IEQUIP.
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.
ROOFING
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
A
r
BARRvA.BERKUS
ALA.
August 16, 1993
Harlan Lee & Associates
310 Washington boulevard
Marina Del Rey, .CA 90292
Attn: Randy
Dear Randy:
Per our phone conversation, I would like to clarify the location of the footing omission described in
the letter from Carl Schneider on August 12, 1993.
1. Due to the fact that the 3 -point bearing trusses have been redesigned as 2 -point
bearing trusses, the footing running the length of the house dividing the
LIVING/DINING areas
from the SLEEPING areas may be omitted. (not required)
If you have any further questions, please call.
Sincerely,
Barry A. Berkus, A.I.A.
Scott Branch
r BA°RY A. BERKUS ;
*' LIC. #C7733
REN. _a "X
. �' `•
223 E. De La Guerra
Santa Barbara, CA 93101
805/963-8901
Fax: 805/966-6846