04177 (GRES)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 78"337 Terra Cott4L t • LA QUINTA, CALIFORNIA 92253
Owner
sonlelva r velopment M
Mailing BUILDING: TYPE.CONST. OCC. GRP. ,
Address � 18 � • rt a'7�i '.S '� Q d . _ A.P. Number- 613-790-001
City Zip Tel.
I t 9206 '"147547,.78056 Legal Description
Contractor
Sama
Address
City Zip
State Lic'
& Classif.
Arch., Engr.,
Designer
Address
A w h
oject Description Buildiit q 9, Plan 2
Tel.
City 1
Lic. # « _ Sq. Ft. No. w
Size Stories
Tel.
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ " Demolition ❑
City Zip State
Lic.,# "
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm Ahat 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 - - - r• • "DATE
OWNER -BUILDER DECLARATION E
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 nol'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
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
AMOUNT
Z75a61 ,
331 U0
JUa(IV
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.)
Electrical
A�'
Plumbing
-75 0 Go
' 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
S.M.I.
6
4 15� ,
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Grading
Driveway Enc.
Date owner
Infrastructure
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.
TOTAL
• CERTIFICATE OF EXEMPTION FROM
,WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
REMARKS
`
-
/,�/ ix fi e11
~ ".• >i,€iA�'".�t,'�„?"i1t,'; iv
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: 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.
ZONE:- BY` - -
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
expiration if work thereunder is suspended for 180 days.�U
FINAL DATE"
INSPECTtOR ct
x
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
construction, and hereby authorize representatives •of this' city to enter the above-
mentioned property for inspection purposes.
4
Issued by:
Validated by:
Date Permit '
Signature of applicant Dale
*Mailing Address
Validation: "
GOLDENROD' ASSESSOR'S OFFICE, HARD COPY - FILE
-. -,. ._ , iY,'. :�.._� s... ...._.- .:rel... �.:.�-..: � r. � �:. i+..'� ..� utf- ... .,__ �. .7..� .....
• City; State, ,Zip
r� 'w WHITE FINANCE PINK APPLICANT, GREEN - BUILDING,
^'�c.....�._a .,T .. -- a r .'t". .. _.. :a•- � r „r. ...,. -c -. .,... .v ....-. _ -. - _.., .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (p s
UNITS
COLL. AREA
SLAB GRADE 1— i ��
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT gr
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
POWER OUTLET
ROOF DRAINS
GAR SO. FT. 0
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO FT. a
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. g
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. 0
=S
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INS . W'
WATER PIPING
NOTE: Not to De used as property tax valuation
�S
4
FLOOR DRAIN
MECHANICAL FEES
^ Qr
o
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
IBATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT. B.T.U.
SO. FT. RESID IA c
SEWAGE DISPOSAL
SO.FT.GAR g 3/.c
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 n ELECTRICAL HEATING 8 AIR COND. SOLAR
c n�
SETBACK
GROUND PLUMBIN
_/
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 1— i ��
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
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$
=S
LUMBER GR.
FINAL INS . W'
AMING —
FINAL INSP.
�S
4
A00FING
L '
^ Qr
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
A L
J
HING 27 —57
MESH
S TIONISOUND
FINISH GRADING
FINAL INSPECTION
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
city. of CALLS 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]
-.3.3I �iPiP�4 L�o�f�9
/-/0-
FRAMING/HARDWARE
�K ,�•�•
PIAN TYPE:
INSULATION
Contractor:
WERMERS MULTI -FAMILY CORP.
98
SHEAR NAILING
avie
DRYWALL
1,2-1,1-96
JOB FINAL
mK
w
COMMENTS/NOTES:
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALLFFORNIA 92253