04114 (SIGN)F
Building
' • Address Palm f ylmle
Owner
_ San Jalainta Smv1
Mailing
' Address • P, -O. Box 35700'.
City Zip
-Houstont TX •77235
Contractor
ABC Graphics
Address
P.O. BOX 1504
78-105 CALLE ESTADO'
LA QUINTA, CALIFORNIA 92253
BUILDING:, TYPE CONST. OCC. GRP.
ri a, A.P. Number-
T.eq�l.
.7wI V °M / N Q►i Legal Description'
Project Description �riiil A6jaie Sign.
torona 91720 714-M�71-1717
State Lic. City
& Classif. 530604 Lic. # 1165
Arch., Engr.,
' Designer
Address Tel.
Sq. Ft.
Size
New ❑
No.
Stories,
No. Dw.
Units
Add ❑ Alter ❑ Repair ❑ Demolition ❑
City
Zip
State
Lic. #
f.+
LICENSED CONTRACTOR'S DECLARATION
;
1 yF
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions,pode, and my license is,in full force and
r - .-
effect.`;,.,..- • ;�`.F
U
_
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 live hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Estimated Valuation �p
$9 r fr�M
"
PERMIT AMOUNT - -
"
Plan Chk. Dep. �. 5� - •• - ,
Plan Chk: Bal. "
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
Const. +rbcs s6!
-
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
Mech.
'
Electrical •' - '
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.)
Plumbing
❑ 1, 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
S.M,I,
. 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'
Grading
Driveway Enc.
Date Owner
Infrastructure
3 .
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. O Certified copy is hereby furnished.
TOTAL
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.
REMARKS
^
Date-Owne
NOTICE TO APPLICANT.r 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. �.
ZONE: BY: _• '
Minimum Setback Distances: '+
Front Setback from Center Line
-
Rear Setback from Rear Prop. Line "
" 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'.
Side Street Setback from Center Line
Side Setback from Property Line '
,
Lender's 'Address
`FINAL DATE IN/SPECTORb�y.
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."ISSUed•by:
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. •
�t
'Date Permit G
_
Validated by:
Signature of applicant Date'
Mailing Address' "
Validation:
e
GOLDENROD -.ASSESSOR'S OFFICE HARD COPY.- FILE
-,aCl::,6 �a .. t...rrv. aa-si�f't`_Y..t:_.�*2•.�.�o ; sW, ". ..w:;tt:. a.ve�a Sft.a�a'. r _ lei?. J., �Yv,_. 3. ._4 t ._.
City, State, Zip
r WHITE FINANCE, PINK APPLICANT GREEN 'BUILDING,
,. '�.fi�t.e-r ,b�iT: n..kic- .F.":,Y:.. _._ -'K.. �'._:e•1� .,1»•.-tY+��...�. .!�e?..�Y: �-- 3.::rbi�i .�i � `6.'sn� 'n
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT tp $
UNITS
SLAB GRADE
'
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. Q
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
FOR SO FT eft
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT.
TEMP. POLE
GROUT
PIPING
CAR P. SO FT. 0DRAINAGE
FINAL INSP.
e
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. @
_$
LUMBER GR.
FINAL INSP.
URINAL
SO. FT. td
ROOFING
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE, Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
VENTILATION
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
FIREPLACE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g- t 1A c
SEWAGE DISPOSAL
SO.FT.GAR V c
HOUSE SEWER
'
CERT. OCC.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
iMECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 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 APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
e
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 SIGNATUPESIINITIALS
GARDEN WALL FINAL
.cit of -L-ak4u.inta
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]
Jq -..?g - 9g
FRAMING/HARDWARE
J •
PLAN TYPE : '
INSULATION
Contractor:
WERMERS MULTI -FAMILY CORP.
`
/D - 29 — 98
SHEAR NAILING
/Q -,2 9- 9S
DRYWALL
K �
/,2 - Aj - 98
JOB FINAL