04173 (GRES)Building
Owner
Mailing
Address
City
.r�t>~tlts
Contractor
�IGG�I iilJ
• P.O. BOX 1504
78-105 CALLS ESTADO
78-317 Terra Coati car• LA:QUINTA,.CALIFORNIA 92253, «
Dave
Main St � . Suite �
Zip Tel.
92686 1 7'14-5
State Lic. City
& Classif. 462014 Lic. #
Arch., Engr.,
Designer
Address Tel.
City~ Zip State .
Lic. #
! LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70pp) t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec_ t.r�' r
£.SIGNATURE "' ".G' DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, after, 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 suchImprovements 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.)
•O 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner �� v
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.
' BUILDING: •TYPE CONST: OCC. GRP.'
A:P: Number."
Legal Description
Project Description �' � 8 ► p1=2
Sq.,Ft.,, .. - . No.
Size Stories
New ❑ Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑
3timated Valuation f
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc. "
Infrastructure
]R ]C'�.'Xlt�jti'i•'•.er"ri�»�: se,wa,t2te.t�. .
TOTAL
- ch
AMOUNT
47
"'-44.76.
75.00
4 ,. 59-
CERTIFICATE OF EXEMPTION FROM
REMARKS
`
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, 1 shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
r '
Date - Owner
NOTICE TO APPLICANT:: If, alter making this Certificate of Exemption you should become
ZONE:
BY: -
• subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
. comply with such. provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line =
" CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
-
Lender's Address ^ '
This is a building permit when properly filled out, signed and validated, and is subject to
P P
FINAL DATE
FNSPEC}T:OR
�tY)( i#r
Y 9 I
expiration if work thereunder is suspended for.180 days.' , '-• �
• -
flit •
I certify that I have read this application and state that the above information is correct.
Issued by:
Date' - Permit
1 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. 4
Validated by:
Signature of applicant Date'
• Mailing Address' - -
Validation:
-
City,' State, Zip =
GOLOENiIOD ,A$5ESSOR S OFFICE HARD COPY - FILE
>.s r--��,. •ice .�c�;3'�' � ��.., .r
' ,' t • WHITE FINANCE PINK APPLICANT GREEN - BUILDING,
�C _•y �. c,.:'[� •+* .r,•.-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl rp $
UNITS
SLAB GRADE 1 —I Cj7
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. C1
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT. a
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. /?
_$
LUMBER GR.
epi
FINAL INSP
URINAL
SO. FT. g
a
OOfING 121-3
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID a I IA c
SEWAGE DISPOSAL
FINAL INSPECTION
SO.FT.GAR 8 3/:c
HOUSE SEWER
CERT. OCC.
GAS PIPING
PERMIT FEE
FENCE FINAL
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING Q/_ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBINd -`$
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 1 —I Cj7
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF`� l �
11
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.
epi
FINAL INSP
AMING r, r{/ �{
FINAL INSP.
a
OOfING 121-3
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
FIREWALL
THING
MESH
SULATIONISOUND,7, 1/
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
city of Ld%4Uin
78.495 CALLS TAMPICO
LA QUINTA, CALIFORNIAi
(760) 777-7012 [FAX] (760) 777-7011
INSPECTION RECORD
Permit # 9808-002
STRUCTURAL RETROFIT OF UNIT
ADDRESS
DATE
INSPECTION
[YES/NOJ
11-3-98
FRAMING/HARDWARE
PIAN TYPE:
/-,3 -'906
INSULATION
Contractor:
WERMERS MULTI -FAMILY CORP.
H-0-96
SHEAR NAILING
'09 � . �• .
% l'� 98
-DRYWALL
OlC �Q
98
JOB FINAL
�..�
COMMENTS/NOTES:
t
A
MAILING ADDRESS - P.O. BOX 1504. LA QUINTA, CALLIFORNIA 92253
3