04232 (GRES)City lZip ( 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. r1
SIGNATURE r11" "' 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, 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.
REMARKS
P.O. BOX 1504
Building
Address
m �`
i 3333
�r,,,�
'Terra Cotten Cts
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 `
.
Owner
oulev rd Developne t
c
..
Mailing
PERMIT
BUILDING:' TYPE CONST. OCC. GRP.
Address
777 S.
Main St., Suite
lob A.P. Number 613-790-001
CityZip
�.
Tel.
: • -
Qrl,nCe
92686 714t547-:806
Legal Description
Contractor
Electrical
Minimum Setback
Project Description -Building 9. Plan kJ
Plumbing
Same
63.00
w
Address
3,416
Grading
City
Driveway Enc.
Zip Tel.
•
State Lic.
���
1,279494
City
Llzar&
70
& Classif.
FINAL DATE
INSPECTOR
Lic. #
.' ...
Sq. Ft:* No. No. Dw.
expiration it work thereunder is suspended for 180 days. .-
6/29/80.
TOTAL
162,01S.67
Size Stories Units -
Arch., Engr.,
construction, and hereby authorize representatives of this city to enter the above-
Designer
mentioned property for inspection purposes.
Validated by:
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address
.
Mailing Address
Tel.
macre ixAQlLida rd
City lZip ( 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. r1
SIGNATURE r11" "' 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, 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
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
r y 's CM')", moi ,4'g1Cr, rj tfi ;,,,f.,�+.t;'.,, ,t k.k _ ;;�) • j
Estimated Valuations'
PERMIT
AMOUNT '
Plan Chk. Dep.
,
Plan Chk. Bal.,
�.
Const.
ZONE:
304.00
Mech.
33.00
Electrical
Minimum Setback
41..78
Plumbing
_
63.00
S.M.I.
3,416
Grading
Side Street Setback from Center Line
Driveway Enc.
•
Infrastructure
1,279494
Frince-Toed
Llzar&
38. IR,
Lender's Address
FINAL DATE
INSPECTOR
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. .-
6/29/80.
TOTAL
162,01S.67
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
r y 's CM')", moi ,4'g1Cr, rj tfi ;,,,f.,�+.t;'.,, ,t k.k _ ;;�) • j
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.
,
Date Owner
NOTICE TO APPLICANT: 11, 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
FINAL DATE
INSPECTOR
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. .-
6/29/80.
I car Illy that I have read this application and state that the above information is correct.
Issued by:
Date Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
y '
WHITE -,FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HAIR p C Y - FILE:
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL SO FT y 1
UNITS
UNDERGROUND
A.C. UNIT
YARD SPKLR SYSTEM
2ND FL SO FT. 0
ROUGH PLUMB
BONDING
MOBILEHOME SVC.
BAR SINK
POR SO FT. y
SEWER OR SEPTIC TANK
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Cl
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SO FT. 0
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN
WALL SO. FT. a
WATER HEATER
SERVICE
FINAL INSP.
URINAL
SO. FT. 43
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
Cu. yd.
$ _plus_x$
WATER PIPING
NOTE: Not to be used as propeAy tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
REMARKS:
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, TEM/PERM
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 a 1+i. c
SEWAGE DISPOSAL
MESH
14 4
SO.FT.GAR @ Av:c
HOUSE SEWER
ULATIONISOUND
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE hL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ^ p� ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING -/
UNDERGROUND
A.C. UNIT
COLL. AREA
AB GRADE `� ��
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FRMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. REINF.I - 0 /�gU/
lll���
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
AMING .��-�
FINAL INSP.
OFING - sA
I
REMARKS:
VENTILATION-
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR"
IREWALL .2-- l
LATHING -�'-
MESH
14 4
ULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
city of LaQui'nta
7&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]
7�- 33.3 -��, v
%/ -5 - 9B
FRAMING/HARDWARE
BiG �•
PLAN TYPE:
II-5 - 9B
INSULATION
Contractor:
V IERMERS MULTI -FAMILY CORP.
%-� - g g
SHEAR NAILING
/ - /m Q8
DRYWALL
//' 98
JOB FINAL
COMMENTS/NOTES:
- g) &F pECc� .tIA�Glnry /o -z9 - l8 ., �•
MAILING ADDRESS — P.O. BOX 1504. LA QUINTA, CALLIFORNIA 92253