04227 (GRES)M 0422
P.O. BOX 1504
Building` 78-105 CALLE ESTADO
Address 78-311 T 3j rra Cotta Ct. LA OUINTA, CALIFORNIA 92253. w
Owner .
Mailing BUILDING:"TYPE CONST- OCC. GRP.
Address' 777 a. Main gt... S uite 106 A.P. Number 613-»790-001
City lZip ITel.
Contractor
Sam
Address
City
y.
'State Lic:
& Classif. 462814
Arch.; Engr., -
Designer., .
Address '
_!;47 _A(15,j IlLegal Description
Project Description 0, Plan 3
,N
Tel.
City
Lic. # Sq. Ft. 71P No. No. Dw.
Size Stories" Units "
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Tel.
City. Zip State
I' I 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
SIGNATURE - • i , 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, after, Improve, demolish, or repair any structure, per 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
�bullds 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
_ _ r
Date Owner
, 1 1
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.
y CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit Is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. ,
CONSTRUCTION LENDING AGENCY .
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's . Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I car ify,that I have read this application and state that the above Information is correct.
I. agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this , city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address Validation:
REMARKS
Ittw�lyy.yw/.Y L 2, y Y
l '' 1i 0
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Estimated Valuation$
Rear Setback from Rear Prop. Line
PERMIT
AMOUNT
Plan Chk. Dep.
FINAL DATE
INSPECTOR
Plan Chk. Bal.
Date Permit
+ �«
Const.
JLt' q a uu
Mech.
3: b ti fJ
Electrical
�4 .
Plumbing
b3 (r V V
S.M.I.
Grading
Driveway Enc.
Infrastructure
a
er=qaa 7 eu
Uzarc.
:50416
TOTAL
id`�:,ti y �..`J . �? !
CA U,
REMARKS
Ittw�lyy.yw/.Y L 2, y Y
l '' 1i 0
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:
City, State, Zip
}
r F WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE,,HARD copy-- FILEt:. _mss
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
N0. PLUMBING FEES ,
1S7 FL SO F1 y $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT.0
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SD FT a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. a
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. fa'
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. Q
_ $
LUMBER GR.1
FINAL INS it/
URINAL
SO. FT. d
FING 2
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to De used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOYDISH)
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
FINISH GRADING
SO. F.T. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a t V. c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/4c
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 ^ /B LECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBINr — �
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. RONFZ/��(% jy� —4
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
_ $
LUMBER GR.1
FINAL INS it/
AMING / — (—�
FINAL INSP.
FING 2
n
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
GAR. FIREWALL
THING
MESH
J SULATIONISOUND ZrZ
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I
City :o f Lak4utata
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]
�T
/- -�%S
FRAMING/HARDWARE
PLAN TYPE:
W-3-90
INSULATION
O� .
Contractor:
WERMERS MULTI -FAMILY CORP.
SHEAR NAILING '
mk;
DRYWALL.
JOB FINAL
COMM ENTS/NOTES: '
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J') AooF 1%C GK. 1j,,41,Z1A1d; 10-29-'m
� Sino/lE ALAR/rI ' UPG�2p0.
MAILING ADDRESS - P.O. BOX 1504, LA QUINTA, CALLIFORNIA 92253
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