04167 (GRES)'r0000� 04167
P.O. BOX 1504
Buildingf 78-105 CALLE ESTADO
;. a
Addres78-3 1 Terr Cotta Cwt* LA QUINTA, CALIFORNIA 92253
Owner
sottlovard 0401Apmut BUILDING:-TYPECONST. 'OCC. GRP.
Mailing
Address 777 S. Main St. t suite 1,06- .... . A.P. Number.
City Zip Tel. ti ,
11"k3e�l�i$ ,�ltl'$l�>+ Legal Description
Contractor Project Description Building 10;, 'Plan I
Add
ress
- City
Zip
Tel.
ty
State Lic. 461014
& Classif.
City
Lic. # ,. M -. ,.. - ,.
926
Sq., Ft --v No. No. DW.
Size Stories- ' Units
Arch., Engr.,
Designer; ::':;,.: ,
New ❑ Add ❑ x•. Alter ❑ Repair ❑ Demolition ❑
Address x`fji .":•�'.
Tel.
y{661 a.r w Included
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 Profession's Code, and my license is in full force and
effect ? >r '•7 , + rr' a ,/ �; I .n {� n
rl
F, '
SIGNATURE - -- - 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 permitto 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 properly, 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
Estimated Valuation y
$66#731 J
'
-
PERMIT t�AMOUNT, `
plan Chk. De p.
Plan Chk. BBI.
Const. ^'° -
Mech. .e'id
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.)'
❑A, is owner of the property, am exclusively contracting with licensed contractors to con-
Electrical •at..;ti•
Plumbing - U
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. 4 tb6 -
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
_
Grading
Driveway Enc. ..
"j 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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
.f
REMARKS r ►
I
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
This section need not be completed if the
( p permit is for one hundred dollars ($100) valuation
v 1�td
' •''}-"r �'+�'r''�""'•�"�� "� •�'+ * ,
or less.)
I certify that in the performance of thg 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.
)
Dale 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 .'
' 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 Street Setback•from Center Line
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.
FINAL DATE -INSPECTOR
0 i 67.2. u e
' 1 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:
Issued by: Date Permit
Validated.by:
Signature of applicant Date '
• Mailing Address - ' -
'• Validation:
GOLDENROD - ASSESSORS OFFICE, HARD COPY - FILE • _ :'
., - .,.+.: _ - _ 2.'t Y. _. �. tx. _:a. •x't .,.. . - _,. ..�Sy,... �.. =.'i r .5t ...�''...3'a .. Y:`•'..... -
.' City; State, Zip
WHITE FINANCE, PINK - APPLICANT, GREEN -,BUILDING,
^.'wW�.'-f. 2 -4-!, , , . _ +. '(:F.. . �- _, ' ,- a _ ac ,... .. - _
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
ISI FL SO Fl rQ S
UNITS
ROUGH PLUMB
BONDING
HEATING (ROUGH)
YARD SPKLR SYSTEM
2ND FL SO FT. a
EWE
ft/Z ROUGH WIRING
•�
DUCT WORK
MOBILEHOME SVC.
BAR SINK
POR SO FT. Cr
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
OUTLET
ROOF DRAINS
GAR SO. FT. 0POWER
GROUT
WATER HEATER
DRAINAGE PIPING
CARP. SO FT. 9
• BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP. /3/A
DRINKING FOUNTAIN
WALL SO. FT. rd
LU BER GR.
NG �J��
v
+
FING
Ol"s��7
VENTILATION
URINAL
SO. FT. Q
REMARKS:
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to be used as property tax valuation
FIRE ZONE ROOFING
FLOOR DRAIN
MECHANICAL FEES
FIREPLACE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTOIIDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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 g t V. c
SEWAGE DISPOSAL
SO.FT.GAR rg V c
HOUSE SEWER
INSPECTOR'S SIGNATUiifSIINITIALS ,
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.�EE
CONST. FEESMI
rECT
FEE PLUMB FEE
STRUCTURE PLUMBING Q ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING Z/ UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE /Z
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWE
ft/Z ROUGH WIRING
•�
DUCT WORK
ROCK STORAGE
UND. REINF./ � �%�
GL-- C
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
FINAL INSP.
FINAL INSP. /3/A
GRADING
cu. yd.
S plus xS
=3
LU BER GR.
NG �J��
v
+
FING
Ol"s��7
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR'
G V LL %. r$'
CI
_
RING
ESH
MIf
/
!c
ION/SOUND,?
FINISH GRADING
FINAL INSPECTION
(J
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUiifSIINITIALS ,
GARDEN WALL FINAL
city of LaQu'i'nta
7&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]
�! 3Ig/ ,c/ �j�f
J / — / 0 ' 9caJ
FRAMING/HARDWARE
PLAN TYPE :
/ —/D — IB
INSULATION
Contractor:
WERMERS MULTI -FAMILY CORP.
SHEAR NAILING
DRYWALL
pK
96
JOB FINAL
COMMENTS/NOTES:
MAILING ADDRESS — P.O. BOX 1504, LA QUINTA, CALLIFORNIA 92253