11607 (SFD)4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 54--625 nerlttt dad LA QUINTA, CALIFORNIA 92253'
is S. Wish
Mailing
Address
City Zip Z31011
eVenice, 9029139--
Contractor
Address
ty
State Lic.
City
& Classif.
Sq. Ft. 1954
Size
Lic. #
I
Arch., Engr.,
New Ol Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit does not include
Designer
Dennis S.
Wish
Address
Tel.
.. same
a5 above
j
City
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State
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. y ,r
SIGNATURE r DATE
OWNER -BUILDER DECLARATION
I herebyaffirmthat 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, cons uct, alter, 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 live 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.)
•❑ I 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. 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 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
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.
I
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
No. 11607
BUILDING: TYPE CONST. SFD OCC. GRP.
A.P. Number 774--205-013
Legal Description
Description
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 Permit
Validated by:
Validation:
Sq. Ft. 1954
Size
No. 1
Stories
No. Dw.
Units
New Ol Add ❑
Alter ❑ Repair ❑ Demolition ❑
Permit does not include
Mack walls
or pools.
Estimated Valuation
$112,386. .1 60
PERMIT
AMOUNT
Plan Chk. Dep.
Z_Ju • ou
Plan Chk. Bal.
3zs • lit
Const.
Mech.
• 00
Electrical
t q u • :)v
Plumbing
144 •'
S.M.I.
J.1 ..1 U
Grading
-U
Driveway Enc.
t
Infrastructure
Arts in k1tWILLIC
St; . t /
TOTAL
'¢s13�,u
��t vJ.t►
REMARKS
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. S0. FT. @MOBILEHOME
SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL S0. FT.
GAS (ROUGH) .
DRINKING FOUNTAIN.
SO FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property lax 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
GRADING
cu. yd.
plus x$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.4,3Q 13
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
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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 XMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
GROUND PLUMBING 7
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 APPJEGUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE 3 U
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.;`f�
FINAL INSP.4,3Q 13
FRAMING aC(13
FINAL INSP. 47— C5''
ROOFING 3 S63G�p
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
I:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND 31-9
FINISH GRADING
FINAL INSPECTION'
!!�`
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
JOB ADDRESS
CITY OF LA QUINTA SUB -CONTRACTOR LIST
PERMIT NUMBER 0/0-7 - O OWNER Az ZL6r BUILDER nok
This form shall be posted on the with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees arellho4dfrized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be competed by applicant. "On File" is not an acceptable response
Trade / Classification
EARTHWORK IC-12)
CONCRETE (C-81
Contractor
Company Name
State Contractor's License
Classification License Number Exp. Date
(e.g. A, B, C-8) (xxxxxx) (xx/) x/xx)
Workers Compensation Insurance
City Business License
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
FRAMING (C-5)
STRUCT. STEEL (C-51)
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-351
DRYWALL (C-9)
HVAC IC-20)
ELECTRICAL IC-101
ROOFING (C-39)
L/r-) 5 E,L7 DaFi' 6
% G 3
7 , C %
S' 3/ l 03
.�T47E-�unt�
`
/�S��IS�.��-mil
�--I-c�
4 13�
SHEET METAL IC-43)
FLOORING (C-15)
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING IC-33)
CERAMIC TILE (C-64)
CABINETS (C-61
FENCING IC-13)
LANDSCAPING (C-27)
POOL IC-53)
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This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
t
Code certifying that at the time of issuance this structure was. in compliance with the various
j'
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 54-625 Avenida Bermudas
IIS
it
Single Family Dwelling 11607
Use Classification Bldg. Permit No.
Group R3 Type Construction VN Fire Zone Use Zone SR
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Owner of Building Dennis Wish Address 1396 Rose Ave
III
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17 I
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City Venice, CA 90291
By; Lonnie Day
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Dote. September 15, 1993
Building Official
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• POST IN A CONSPICUOUS PLACE
-