09239 (ELEC)r�
Building
Address 52-920.. 1
Owner
Dan Hielte
Mailing
Address
City Zip
T.sa
Contractor .
Address
City lZip
P.O. BOX 1504 C e'" No.,
78-105 CALLE ESTADO /
io LA QUINTA, CALIFORNIA 92253
Tel.
State Lic. I City
& Classif. Lic. #
Arch.; Engr:,'
Designer
Address Tel.
City Zip State
Lic. #
r LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 6 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
OWNER -BUILDER DECLARATION . '
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
3 perint�tW.construct,:affer, 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) or
.Division 3 of the Business and Professions Code, or that. he is exempt therefrom,, and the basis
'for the alleged exemption. Any violation or Section 7031.5 by 'any applicant4or a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars.($500). -
_ �I -as owner of,the property, or my employees with wages as their sole compensation, will
di3 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 finprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Seca 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 Owneri x
v er v - • fir
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
O 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 IS 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 �£:'7
NOTICE TO APPLICANT: 1 Wafter tx7s"jCeRf zk te� of Exemption you should become
subject to the Workers' Compensation provision 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
11 0923
ILDING: TYPE CONST. WE OCC: GRP.
P. Number
Legal Description
Project Description
r
Sq. Ft. No. I No. Dw. '
Size -Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk.: Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
3 .
Plumbing
S.M.I.
�. -.
Grading
Driveway Enc.
Infrastructure
TOTAL
33.50
REMARKS
aw it;
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 Propertj,Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Y. ~_•I.. Y. .
CONSTRUCTION ESTIMATE
NO. , ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOB] LEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
DRAINAGE PIPING
WALL SD. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WA1 ER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
x$ _ $
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP 5
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.
SO. FT. ® c
BATH TUB
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SQ.FT.GAR ® 3/.c
HOUSE SEWER
GAR. FIREWALL
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 APPJEQUIP.
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 5
A
FRAMING 21t'/9/ //,/!�
!! ��- sssYYY
FINAL INSP.
ROOFING
ft -
/d ' " 1411 /
1411, M;'111fl
/� /�
//L� ��q • "�r?'�`
(((
Ilk
REMARKS:
a
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
_
w
GAR. FIREWALL
LATHING
MESH
17/
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
0
f
78=1;05' CALLE ESTADO. — 'LA QUINTA; CALIFORNIA `.92253 - (6.19) 564-2246
FAX (619)564-5617
Don Hjelte
52-920 Rubio
La Quinta, CA 92253
Dear Mr. Hjeltec
This letter is to respond`'to your, -requested extension for your
building permit #09239 for. an addition of a:s,ub panel located at
52-920 Rubio. b
The Building and'. Safety Department will grant -,a.18D.: day -extension
of the above :permit;. The perm',t will be •:extended.; to: February 20,
1992. A permit: extension, may;.�be granted by= the Building O-ff`ical .
only one .time -,°.according,. -to Section 30.3(d) of, the 1988 Uniform
Building Code.,
Should your permi't.expire,after the abovegranted yextension date,
a new` permit would be required to be iss`u:ed for the.�pro.ject to -be
completed. Abatecnent-proceedings'could_ result should a job be
abandoned for a period exceeding -..18.0: days after a permit has
expired.
Thank you in\advance for your assistance.
Sincerely;
BUILD-ING AND SAFETY DEPARTMENT
Tome -Hartung,
Director of Building and., Safety
TH/lc
LTRMH07
MAILINGAD.D_RES P.O. B•OX` 1504 - LA QUINTA•; CALIFORNIA 92253
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MAILINGAD.D_RES P.O. B•OX` 1504 - LA QUINTA•; CALIFORNIA 92253
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