05112 (MFD5)Building
Address
Owner
Mailing
Address
City
[ax'a?1
Contractor
Address
T4hf 4 4 QA ba I
78-159 Crimson Drive
City lZip
P.O. BOX 1504 N o . WMAL Z
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
lair. A.P. Number ( X13—t9i�--t)t74
vR Legal Description
Project Description T2L.4 -44.�Z1
II
f
State Lic. City
& Classif. P311261 Lic. # 1177
Arch., Engr.,
Designer
Address
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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 affirlm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,8usihess and Professions Code: Any city or county which requires a
permit to eruct, after, 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) of
Division 3 of the 131siless 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 rive 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
briA2s 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
orimprovement is sold within one year of completion, the owner -builder wig 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 comtractor(s) licensed pursuant to the Contractor's License law.)
❑ 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' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 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., lf, after making this Certificate or 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
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
Sq. Ft. 926
Size I
No. No. Dw.
Stories Units "
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition
❑
I
Estimated Valuation
566731
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
777 82
Const.
1A . Q)
Mech.
.,
Electrical
A
Plumbing
75,00
S.M.I.
A AA
Grading
Driveway Enc.
Infrastructure
1 , 501. 45
V. a,e► -
Tin 4. A
R_ IS
TOTAL
A a 15 e "a t e:7
REMARKS
4. 1, `
�1y4r} is l'i j X Xi J 1711.K. L.Ta
1
`iJ.f.La..C) f.l
\
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 12 8/881 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. ® $
UNITS
SLAB GRADE ( I� qG�
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. @
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH) METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
GROUT
DRAINAGE PIPING
CAR P. I SQ. FT.
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
-Plus-X$-=$
URINAL
SQ. FT. ®
FRAMING Q,
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
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/461FINAL
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WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L 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
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
INSPECTI
SQ.FT.GAR ® V4c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FIPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING// z.4 ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE ( I� qG�
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF. 1/G) vv,,
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. 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 Q,
FINAL INSP.
ROOFING
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/461FINAL
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
'GAR. FIREWALL
LATHIZG
MESH
INSULATIONISOUNell
FINISH GRADING
INSPECTI
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
'
GARDEN WALL FINAL
cityp.f .. int
'LaQua
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
(760) 777-7012 [FAX] (760) 777-7011
INSPECTION RECORD
Permit # 9808-002
STRUCTURAL RETROFIT OF UNIT
ADDRESS
DATE
INSPECTION'
[YES/NO]
7
`8
FRAMING/HARDWARE
PLAN TYPE: AX--,
j
INSULATION
Contractor:
WERMERS MULTI -FAMILY CORP.
SHEAR NAILING
DRYWALL
JOB FINAL
COMMENTS/NOTES: h1
In7cePie-8 13y 9, P. g)A
L,4- IJ
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALLIFORNIA 92253