04166 (GRES)414 a I
_ . 4.1
P.O. BOX 1504
78-105 CALLE ESTADO
Address 78-339 Terra Cotta Ct, LA QUINTA, CALIFORNIA 92253
Owner t ..
-soulava, rC Dave .opI# ent BUILDING: -TYPE CONST. OCC. GRP.
Mailing
Address 777 S. Main Stu M Suite 1`45 � ...„ , « • A:P: Numbed „ < , 6�3-;790-001 � {
City Zip Tel. ^
orange > 7;w,'�'"Q►- Legal Description
Project Description Dtx�..ding 9 r �an 3
Seat®
ress ,
City :. , Zip Tel.
State Lic.462818 City ^�
& Classif. Lic. # Sq., Ft. + No.
Size Stories
Arch., Engr.,
Designer
Address Tel.
-'; City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
• 1 hereby affirm that) am licensed under provisions of Chapter 9 (commencing with Section
7000), of Division 3 of'the Business and Professlons pode, and my license is in full force and
effect%fi
SIGNATURE,^ --'.,r," "DATI
t' `s52i-'°xy OWNER -BUILDER DECLARATION
1'•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 ,consfructralter, improve, demolish, or repair any structure, prior to its issuance also
requiresthe: 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 such improvements are not intended or, offered for safe. 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 1, 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
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.
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 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 youshould 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. - -
New ❑ ' Add ❑ Alter ❑
No. Dw.
Units
Repair ❑ Demolition ❑ '
Garage Included
Rear Setback from Rea . Line
CONSTRUCTION LENDING AGENCY.
Side Street Setback from Center'LI
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.)
Estimated Valuation
Side Setback from Property Line
PERMIT
AMOUNT
Plan Chk. Dep.
Lender's -Address
Plan Chk. Bal.
y .277.82
Const.
33 4.00
Mech.
• 36.00 .
Electrical
-45, 4
Plumbing„#)]
, Issued by:
S.M.I.
4a66
Grading
Driveway Enc.
Infrastructure _
•
��' • 451,
Validated by:
!
r Signature of applicant Date
\
i'
Mailing Address
Validation.
TOTAL i2p+2t►I
REMARKS
?" i' 0 ej s, ?,o,3U. .
ZONE: BYE
Minimum etback Distances.
•Front Setback from Center Line
Rear Setback from Rea . Line
CONSTRUCTION LENDING AGENCY.
Side Street Setback from Center'LI
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.
6/27/88
r' I certify that l 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 hid, city to enter the; above
- . mentioned property for inspection purposes.
Validated by:
!
r Signature of applicant Date
\
i'
Mailing Address
Validation.
City, State, Zip
'F7@
GOLDENROD ASSESSORS OFFICE HARD COPY -FILE.
x' WHITE FINANCE, PINK APPLICANT, GREEN BUILDING
�s.s'�li s.Ys.iU .,r5+�t.. .: �F t�.;-,.-SrA,:...:+.i .._C �«EY'?: .:: .,:-.: �:t.�.. ..,�. Tv.:.. :s.. -.'. ...,.. ��:.r:
.r...�: .. ...Y.'�;. .re_r�`k:L. ,:3-..�.
e`,ib P. - �. .: n �:: �.1.. .. .. ✓ 5.4:�. Y...tt!'��..+.a,.R.a.':... 3� �:k ��. Cl
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO F1 rp S
UNITS
COLL. AREA
OP
AS GRADE (j��
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. q
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT a
DUCT WORK
ROCK STORAGE
/
D. REINF. �c�t(
POWER OUTLET
ROOF DRAINS
GAR SO. FT. is
HEATING (FINAL)
OTHER APP.IEOUIP.
,4�tz
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CARP. SO FT. IC
GROUT
WATER HEATER
DRINKING FOUNTAIN
WALL SO. FT. @
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
URINAL
SO. FT. (d
GRADING
yd.
plus xE
=S
ESTIMATED CONSTRUCTION VALUATION S
RAMING2/
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTONDISHI
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ t V: c
SEWAGE DISPOSAL
SO.FT.GAR (g 3/.c
HOUSE SEWER
FINAL INSPECTION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE bL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ii zk ELECTRICAL HEATING 8 AIR COND. SOLAR
r
SETBACK
I/
GROUND PLUMBIN;jI
-/-1 60' fI
UNDERGROUND _� ��
A.C. UNIT
COLL. AREA
OP
AS GRADE (j��
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER
ROUGH WIRING
DUCT WORK
ROCK STORAGE
/
D. REINF. �c�t(
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
,4�tz
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSCU.
GRADING
yd.
plus xE
=S
LUMBER GR.
RAMING2/
FING — ���
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPAR�K7 ARRESTOR,
RING
MESH
TION/SOUND 2 r�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUlESlINITIALS
GARDEN WALL FINAL
city of LaQuinta
78-495 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]
17--IM
//-/0- 9B
FRAMING/HARDWARE
oK •�.
PLAN TYPE: !
1/- /D - 9B
INSULATION
Conrractor:
WERMERS MULTI -FAMILY CORP.
98
SHEAR NAILING
- 9,9
DRYWALL
®� ..8-
/12 - /J 96
JOB FINAL
ove
COMMENTS/NOTES:
1:51m ollIE ,QL Af172
MAILING ADDRESS - P.O. BOX 1504. LA QUINTA, CALLIFORNIA 92253