9606-038 (SFD)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 >
` 9 p
Date f� h 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).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
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 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 & policy. no. are:
Carrier Policy No.
>'i'A:rf; FUM) f'37iti�tg�)4
(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 bcome subje �t to the
workers' compensation laws of California, and agree thIt if (should become
subject to the workers' compensation proviaion� of°SeA 700 o she Labor
Code, I shay rthw•ith comply with those provisions.
Date: r FAoolicant
Warning`. Failure to secure Workers' Compensation coveragd 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
appmatlon.
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 subjectpermit to cancellation.
I certify that I have read this application•and stat that/the above information is
correct. I agree to comply with all City, and State las relating to the building
construction, and hereby authorize reprd'sentalives of this City to enter upon
the above-mentioned property for inspection purposes. /
Signature (Owner/Agent) . ='.rt '� - Date �'
/
Al.
# °°NTR°`#
BUILDING PERMIT PERM T9606-0348 3493
DATE VALUATION S°t3+^� LOT TRACT
JOB SITE 19-075 KiVIS'l.'HO .Uik Qi IN I.A ORIV E
APN 649470-61113
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
",'.1 , J1a:;1:1��E 1 i1's4'a7LCi1' 11 1 'r
f','1t%, 5 C"t)r7";fRl'K"T'.Ic)N
110, , OX. 1.710
79295 JUNN0 0 LA' Otx.Ll~f': A. UP.
LA 01 it CA. 42751
LA QjJltYfA CA 97n53
ftiltl)771.�194t
(619)721.1941 f°l1L4 29%
USE OF PERMIT
. DC7, F�T�FtMUf TXW%ti NOT .iNr_Jj17i;3T1fA ,, - AT).OR i'00l:.'iT#k �.3�J.�8 h'�tR Ai{'!' 4 i9� 1•TtiSC,tt"
i.+i-AM''g f'i+<1?I)F011) A()AIT4`rf' )3Al.�Nt� II PPR Ar.;R +�'i4WNT W;,nl C°omoo-rV
_2561 }0 SF
{1AiZATr! f� Ahil'�+i{_'t MS05.00 81'
t�� 'i'I.1iTEl'A';y;i> COST OFt:YaNS t t(:'!'ttav
235,9. .1)
CoNsirm.rT'ToN ns 101-1,00-418.000 $1.1t5_50
i'.f.ANCHUCK F12�', 101.000439 -Melt $912.84
h1f f„`11t�kfTt'Al i i f 10i. -+121_000 5-142.00
k i:4"t'12iQttT V , : ' 101-i14()-+12040) 11f3, 74
)'i,�"A�i3rt�fCiF'1;73 li11>4!)4 '11!� 4!}(3 31R�.y�
Sit N(i 7bli010 1;M -.RLSID 101-010-24.1-000 $23:W
OR A01NO .FFF 101-000-414,-000
TNFRAS'D'RiTMIRE.Ft-'ia, T1 -000443-342 $S.212.:5
sua-'1um END PLAN (1H.WK.
7,1x)5_;31)
1'S
t.f{atiS T'k%:-1'/it1) FEV
5000
TOTAL PERMIT fff,S DUE NOAV
S7;165-10 .
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade %—
Return Air
Steel 7 —/(,.
Combustion Air
Roof Deck —
Exhaust Fans
O.K to Wrap —Y
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath Is
Drywall - Int. Lath 77
Final 7 -
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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 7 V —2r2
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral 7
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test j
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final - S
Utility Notice (Perm)
COMMENTS:
�lr1v` �✓� d
I-,15
• is - ,
a
_ CITY OF LA QUINTA -
.ya a BUILDING & SAFETY DEPARTMENT
m-7012
INSPECTION REQUEST LINE _
777-7153
Owner T D DESERT DEVELOPMENT
ContractsP�S CONSTRUCTION
9606-038
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-075 RANCHO LA QUMTA DRIVE.
JOB ADDRESS
SFD-PERAUT DOES NOT INCLUDE BLOCK
WALLS %-
J-,,
OF INSPECTION DATE INSP.
I
P.O. BOX 1504 APPLICATION ONLY
Buildin Q //%% / ��% 7&105=CALLE ESTADO
Address / -� /�Gi1G�lo I/4 wt//?�L�`i4�QUF�LJ%ceEAIIFORNIA 92253
,Owner
t
Mailing
Address/Ooa �S Cat c -4c -jc.-q.�" f /A L Pow (71
City ( Zip
'CS CavST, IfvC__
Aaaress
(�'o %�', t _7( ( ,�"
N, Ce c� "r Zi� 7 Z T � 7/7?/
State Lic. '/ City
& Classif�`I 4� %� Lic. #
Arch., Eng r., S .A•
Designerf ,, 4 ST :'C A4 A"4
Address / Tel
CityState
Tip5vfft
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, 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 five hundred dollars ($500).
F] 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.)
as ownerof 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.)
17 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'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars (8100) 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: 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 it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agreeto comply with all city and county ordinances and state laws relating to building
cons'ruction, 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
BUILDING DIVISION
11LDING: TYPE CONST./ OCC. GRP. -
P. Number 6 q !q " _37o "- 003
lgal Description TrQN-(-t 7 -7 9 4-2 (An f i;(,� (-e' 5-0
Project Description
WA -0;.4142.4 3 20 t , SC C/
ICP e><r 5 cr'-fC Lim Y� iY�c7
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
r
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback frcm Center Line
Rear Setback fro:Tt 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'
1ST FL. SO. FT. @ $
2ND FL, SO. FT. @
POR. SQ. FT. @
GAR. SO, FT. @
CAR P. SO. FT. @
WALL SO. FT. ?
SO. FT. @
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
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
t SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL -
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1'A c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
REMARKS:
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 R 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.
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