04235 (GRES)P.O. BOX 1504 '
Building 78-105 CALLE ESTADO ,
Address 78-351 Terra Chita �i.•o tr, LA QUINTA, CALIFORNIA 92253
Owner • ,
. BUILDING:. TYPE CONST.. OCC. GRP.
Mailing
Address 777 S. Haan st. ♦ suite 1`06 - A.P. Number,'.. - 6.13..799-00 1
City Zip Tel.
Ora i9 X32686 714-!$ Legal Description
Contractor, - Project• Description ' �i��.B�L�icx 1.6 . Plan 3
a�aam
Address
City r
Zip
Tel.
State Lic:$
City
7$3
& Classif.
#
Sq. Ft.,,,
No. a, No. Dw:,
Size
Stories Units
Arch., Engr., '
Designer
New O Add 0
Alter ❑ Repair O Demolition O
Address .
Tel.
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 r
• effect., •Y ti•-,�"
SIGNATURE " MATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
ipKS�1D
. reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
P
permit to construct, atter, 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
PERMIT
AMOUNT
i the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
Any Section 7031.5 by for
Plan Chk. Dep.
• .for'the alleged exemption. violation of any applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
i -
O 1, 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
Const.
x
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,
McCh.{
_
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
Electrical
of proving that he did not build or improve for the purpose of sale.)
0,1, as owner of the property, am exclusively contracting with licensed contractors to con-,
Plumbing
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.1,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O I am exempt under Sec. B. & P.C. for this reason '
Driveway Enc.
Date Owner
Infrastructure
1_ •
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.
-
•
TOTALi6pti,L.�6i
CERTIFICATE OF EXEMPTION -FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
♦ t ,tn € �1
L} hiiti�sl�id;}fia,, ,j�j�i
110%V410
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
-
employ any person in any manner so as to become subject to the Workers' Compensation -
Laws of California.
Or
'
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become '
ZONE:
BY:
subject to the Workers' Compensation provisions or 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
Ihereby 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,'' (�,
I certify that I have read this application and state that the above information is correct.
Issued by;
Date Pe?mit.
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:
Q
City, State, Zip
WHITE -FINANCE, -PINK APPLICANT GREEN BUILDING, GOLDENROD - ASSESSOR'S OFFICEHARD COPY -FILE ri f�
I:}�a�rr•1� a:..3. :t•t .�..:. _,.. _. ,_.c-i..Ni_... - •.:..-+. -1 .. ...•- .r ',. -. "!Ff..,�iv..:. �. ... -.i �£'..;•i•i �..- y.... .w..- .. "<�el-, _._. r. �. ._.i.i ...,,� . �..�.w. ...:w..Y'"�,.:i^..Jr._..�.�.w. ✓ a' ... w, .:1s':
CONSTRUCTION ESTIMATE I NO. ELECTRICAL FEES NO. I PLUMBING FEES
IST FL - SO Fl y $
UNITS
UNDERGROUND
A.C. UNIT
YARD SPKLR SYSTEM
2ND FL SO FT. a
ROUGH PLUMB
BONDING
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
SEWER OR SEPTIC TANK
ROUGH WIRING
POWER OUTLET
ROOF DRAINS
GAR SO. FT.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CARP. SO FT. Q
GAS (FINAL)
TEMP. POLE
DRINKING FOUNTAIN
WALL SO. FT. (d
WATER HEATER
SERVICE
FINAL INSP.
URINAL
SO. FT. td
WATER SYSTEM
ESTIMATED CONSTRUCTION VALUATION $
GRADING
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to be used as property 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
ILAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPEAM
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 1v c
SEWAGE DISPOSAL
MESH
SO.FT.GAR 3/,c
HOUSE SEWER
NSULATIONISOUND �J v
v
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL I
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 PLUMBIN3
UNDERGROUND
A.C. UNIT
COLL. AREA
B GRADE g
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
OUND. 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$
_$
LUMBER GR.
FINAL INSP.
AMING Z��
FINAL INSP.
ROOFING,�5 g
✓
TO
��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
.Q
G L2-�� lJ
LATHIN
MESH
NSULATIONISOUND �J v
v
FINISH GRADING
FINAL INSPECTION fg/ �(
'
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
city of LaQui"nta
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]
9's - 3S'1 -,,gi R4 a"- LEA
f /- j4 - 9.8
FRAMING/HARDWARE
PLAN TYPE: ,�
//-/O 98
INSULATION
J.
Contractor:
WERMERS MULTI -FAMILY CORP.
SHEAR NAILING
J.
/ j-/,3 - 9g
DRYWALL
JOB FINAL
J,y
COMMENTS/NOTES:
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALLIFORNIA 92253