04231 (GRES)Building
Address
Owner
Mailing
Address
City
Contractor
Address
City •
4414
P.O. BOX 1504
78-331 Terre Cott& Ct. LA QU.INTA, CALIFORNIA 92253,
v.
BoulevardDevelopmant1 BUILDING:'TYPE CONST.- OCC. GRP.
777 S. Main St., Suite fQ6 .. _ , A.P.Aumber 613-790-001
Zip Tel.
92686 714a.,50` 805((S Legal Description v
Project Description *But iding 0, Pian 3
Zip I Tel.
State Lic. City
& Classif. 4040 1W Lic. #
Arch., Engr.,
Designer
Address Tel.
.. . ,.. Sq. Ft. ,. 70 No.
Size Stories
City(Zip ( State
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
effect. %
_SIGNATURE '-d':.!w�' <.- r ,c:<•r' r'T;..! R 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 five hundred dollars ($500). -
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
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 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.)
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.)
O 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
O Copy is filed with the city. O 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.)
I certify that in the performance of tha 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 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
New ❑ Add ❑ Alter ❑
�F.'
No. Dw.: .
Units -
Repair ❑ Demolition ❑
C SI.rAaa included
ZONE:
BY:
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
i uu,
Electrical
41 a 7U
Plumbing
63 *U0
S. M.I.
Grading
Driveway Enc.
Infrastructure
9 * *4
TOTAL ` PaA A Q?
r,._.} a.r, k it '•.' • .
REMARKS
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
construction, and hereby authorize representatives of this city to enter the above- „
mentioned property for inspection purposes. Validated by:
Signature of applicant Date '
Mailing Address Validation:
City, State, Zip'
WHITE -FINANCE, PINK' - APPLICANT, GREEN -BUILDING, GOLDENROD - ASSESSOR'S OFFICE HA COPY - FILE41
a
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL SO FT y $
UNITS
UNDERGROUND
YARD SPKLR SYSTEM
2ND FL SO FT. C
�y
AB GRADE 1/i Z y �"p
ROUGH PLUMB
MOBILEHOME SVC.
BAR SINK
POR SO FT of
STORAGE TANK
FORMS
SEWER OR SEPTIS TANK
POWER OUTLET
ROOF DRAINS
GAR SO. FT. a
DUCT WORK
ROCK STORAGE
FOUND. REINF.,/. L /�Cb
/
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO FT. C
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
DRINKING FOUNTAIN
WALL SO. FT. @
TEMP. POLE
URINAL
SO. FT. (p1
SERVICE
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
RA 1NG
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OFING �� q
O — /
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. fgl c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 11A c
SEWAGE DISPOSAL
. FIREWA L
SO.FT.GAR JV:c
HOUSE SEWER
LATHING
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 ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING /-/
UNDERGROUND
A.C. UNIT
COLL. AREA
�y
AB GRADE 1/i Z y �"p
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIS TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.,/. L /�Cb
/
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.
FINAL INSP
RA 1NG
FINAL INSP.
OFING �� q
O — /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
. FIREWA L
LATHING
MESH
TIONISOUND%
c�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATL?RESlINITIALS
GARDEN WALL FINAL
city of LaQu*inta
78-495 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]
;e4eA fI
1 ��.� - 9�
FRAMING/HARDWARE
p/C , J
PLAN TYPE :
�/-�- 96
INSULATION
old
Contractor:
WERMERS MULTI -FAMILY CORP.
/J-- 6 - 98
SHEAR NAILING
ow .�
9,5
DRYWALL
exl
/,2 -//- 9S
JOB FINAL
ow JB,�
COMMENTS/NOTES:
SinolC,� �.GA2/n !/%Jc�r•E'ADt
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALLIFORNIA 92253