04164 (GRES)Building
Address
Owner
Mailing
Address
City
Contractor
Address
City -
State Lic.
& Classif.
Arch., Engr.,
Designer •
Address .
� A
1, 4.16
P.O. BOX 1504
78-105 CALLE ESTADO
78--319 Torry Cott& Gtc LA;QU.INTA,.CALIFORNIA92253••.vBoulevard DeVelopMent
BUILDING'' TYPE CONST: OCC. GRP.
777 SJ-ftln St.* Suite i�?�.�...:, <A:P: Number 613_-790-001
• - -
Zip Tel. „
92686 1714 .47-%8056 Legal Description
Project Description Building So Plan !1
Same_
r
Zip ITel. „
L;Ityt
462814 Lic. # .......,.. Sq. Ft. W No. No. Dw. t
Size Stories Units I
New O Add O Alter O Repair ❑ Demolition ❑
Tel. I aaraqo. included
City
Zip
State
-
'
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
'''aaaaaa °°°°°°7000) of Division 3 of the Business and Professions Code, and my license is in full force and
XIt 14
S GNATURE DATE
• OWNER -BUILDER DECLARATION
Estimated Valuation aa.e� g
$6 6 7Jcg�1
I hereby affirm that.1 am exempt from the Contractor's License Law for the following
r s
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
.$66r731
'
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
PERMIT '.AMOUNT '
` -• the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
.,AMOUNT
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 for
Plan Chk. Dep.
applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (8500).
„
„, �.j�y� rp J
Plan Chk. Bal. ,* ;1
O 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
�. ,, -,
Const.
Professions Cod&:'. The Contractor's License Law does not apply to an owner of property who
�{f)
builds or. improves; thereon and who does such work himself or,. through his own 'employees,
Mech. 36(�
provided that. such' improvements are not intended or offered for sale. If, however, the building_
or improvement'JSs Sold'within one year of completion,. the owner -builder will have the burden
Electrical
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-
Plumbing 00
structthe project"(Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply toanowner of property, who builds or improves thereon, and who contracts for
S.M.I. - r • �
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
`
. -
Grading
O I am exempt under Sec. B. 8 P.C. for this reason
-
Driveway Enc.
Date owner <
Infraastructure
q d
WORKERS' COMPENSATION DECLARATION
•r
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. O Certified copy is hereby furnished.
. .. .+
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
t1�
DD 5,t,t:k_��±� A 10'.;1!1.ft3 -; 10-26+110',; T •, 0
or less.) -
I certify that in the performance of thg work for which this permit is issued, I shall not
AV �.rjWY:9 A rVria..,,s.
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
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, Cl Code.)
Side Setback from PfOpt?rty Line
Lender's Name : __ -
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE I NSeO�R
it thereunder is for days.
expiration work suspended 180
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 -
r
men tioned property for inspection purposes. = .
Validated by:
Signature of applicant Date-
ate
Mailing
Mailing Address
Validation:
City, State, Zip =
+ y WHITE - FINANCE PINK APPLICANTD
, GREEN - BUILDING, GOLDENROD - ASSESSORS OFFICE, HARD - FILE
e: y
_
Ps, '..,,. Sal+" _,... •,41.4. - -..'n,.. . -r. ,. t • .='sr t.�.=; i? .5- ,+_C. ..�ti .. ._,C1 , .,......
�.r � .,. _. .....
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IS7 FL SO FT (p S
- UNITS
SLAB GRADE Q7'�
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. 0
TEMP. POLE
GROUT
DRAINAGE PIPING
CARP. SO FT. e
FINAL INSP.
BOND BEAM
WATER SYSTEM
DRINKING FOUNTAIN
WALL SO. FT. 0
=$
LUMBER GR.
FINAL INSP% L—
�f
FAMING /�- ry /��
URINAL
SO. FT. rd
/y///►
/
ESTIMATED CONSTRUCTION VALUATION $
REMARKS:
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.0OOL HOOD
SIGN
WASHER(AUTONDISHI
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SPARK ARRESTOR
LAUNDRYTRAY
AIR HANDLING UNIT CFM
G FIREWALL j
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 @ 1 V. c
SEWAGE DISPOSAL
'
SO.FT.GAR (g 3i4c
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMI7 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 Z_ELECTRICAL HEATING 8 -AIR COND. SOLAR
SETBACK
GROUND PLUMBING -ZT V
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE Q7'�
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
d
FOUND..REINF—�6"
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 zS
=$
LUMBER GR.
FINAL INSP% L—
�f
FAMING /�- ry /��
FINAL INSP.
OOFING Z• � �yt;
/y///►
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
G FIREWALL j
MESH
4-4 Of
INSULATIONISOUNDZ/ Z
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUF:ESlINITIALS ,
GARDEN WALL FINAL
city ofLaQu'i'nta
79495 CALLE TAMPICO -4
LA QUINTA, CALIFORNIA
(760) 777-7012 [FAX] (760) 777-7011
INSPECTION RECORD
Permit # 9808-002
STRUCTURAL RETROFIT OF UNIT
ADDRESS
DATE
INSPECTION
nS/NO]
'%8 - ,;19
//- ,3 - 98
FRAMING/HARDWARE
OlG
PLAN TYPE:
%- 5 - 9s
INSULATION
Contractor:
WERMERS MULTI -FAMILY CORP.
P--0 - 946
SHEAR NAILING
log
1 %"lo " 98
DRYWALL
OlL
JOB FINAL
mle ,d
COMMENTS/NOTES:
MAILING ADDRESS — P.O. BOX 1504 - LA QUINTA, CALLIFORNIA 92253