12521 (RER)}
t' 1
4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 51-870 Juarez LA QUINTA, CALIFORNIA 92253
Owner Thomas Mercier,�
Mailing
Address
City Zip Tel.
Contractor
Owner/Builder
Address
Zip j Tel.
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City I Zip I State
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 Contractors 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).
❑ 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.)
O 1 am exempt under Sec. P.C. for this reason
_1_r JJ � i�
rate --` �wner
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'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) �,�w
I certify that in the performs e(TIE`bf `thp for which this pe mit is issued, I shall not
employ any person in any man er so as to become sub'ect to he Workers' Compensation
Laws) C rfor ' f 1
Date_ caner tt.>�� /
NOTICE TO APPLICANT: If,aRer making this Certificate 014RTe-mption you should become
W15ject 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
No. 12521
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Repair Lira damage
bedroom, and bath.
in master
Sq. Ft.
Size
No.*� No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$10000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
25.00
Mech.
Electrical
15.00
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
40.00
REMARKS
ZONE: BY: I
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line t
Side Street Setback from Center Line ` s
Side Setback from Property Line
FINAL DATE AftsfCET — - '
Issued by:
Validated
Validation.
i'
j
I r r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMPING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2 ND FL. SO. FT. p
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING �/ Z.Z�7G
[' 7
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
I ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CARP. SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
FINAL INSP. ?�J�
r!
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 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 �/ Z.Z�7G
[' 7
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. ?�J�
r!
FINAL INSP. //-z
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING y[J'"l�
—r
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL Z-7 3
LATHING
MESH
INSULATIONISOUND 1 2✓
; `
FINISH GRADING
FINAL INSPECTION —
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
c
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78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
October 21, 1993
Maria Arroyo
IMPERIAL IRRIGATION DISTRICT
P.O. Box 1080
La Quinta, CA 92253
RE: Emergency Request to Disconnect Power at 51-870 Avenida Juarez
Dear Maria:
The single family residence located at 51-870 Avenida Juarez has received major structural
damage due to a recent fire and has been ordered vacated due to its hazardous condition.
Please consider this letter an emergency request to disconnect all electrical power to the
residence as soon as possible for the prevention of further damage that my be caused by
internally exposed or damaged wiring, etc.
Respectfully,
CIT OF LA QUINTA
6
Don Whelchel
Code Enforcement/Building Specialist
kt
MAILING ADDRESS - P.O: BOX 1504 - LA QUINTA, CALIFORNIA 92253.