04274 (SATT).7€433 Terra tta Ct. aT TRY 4
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address,e ,LA QUINTA, CALIFORNIA 92253
27
Owner ?
Boulevard Develommilt BUILD
ING^ TYPE CONST- OCC. GRP. -
Adding §�3- 79Ow O2 r
Address7•A 6s'a�� 1�6 , r., - �. _ . _
•- A.P: Number'
City Zip Tel. *-
Oran �� �2�i�� 714.4 547,rQQ56 _ Legal,�escription j
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Contractor Project Description ` .D.
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saw
ress r
IZip -ITel. -
State Lic. City
& Classjf. 462814 Lic. #
Arch., Engr.,
Designer
Address' Tel.
e
City?-,•;;s,r3;L<. Zip State
1•. ,il j!:...
•,� ;�r.y, Lic. #
-. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Dlvisioh'3 of the Business and Professions Code, and my license is in full force and
• effectr "r
SIGNATURE r "-,rr. DATE
• OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
Sq. Ft.- !36 No. No. Dw. ;
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation��
permitto construct, alter, Improve, demolish, or repair any structure, prior torts issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
the provisions of the Contractor's license Law, Chapter 9 (commencing with Section 7000) of
Division 3 of theBusiness and Professions Code, or thathe is exempt therefrom, and the basis
for -exemption. Any Section 7031.5 'any for
Plan Chk. Dep.
,
the alleged violation of by applicant a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. Bal.
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
Const.
« UU
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,
Mech.
:53 -OU0 '
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.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
�r�� �y tp�►
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
4 builds improves thereon, for
S.M.I,
[�
does not apply to an owner of property who or and who contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
a :J 3.•
O lam exempt under Sec. B. 8 P.C. for this reason �
,
Driveway Enc.
Date owner
Infrastructure�'�
•
r
' 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.
-
't
TOTAL��l�1`J.5
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CERTIFICATE OF EXEMPTION FROM
'
REMARKS
WORKERS' COMPENSATION INSURANCE
(This'sectioA need not be completed if the permit is for one hundred dollars ($100) valuationY-k,
"yE.�•�i` a c•e.
or less.)
I certify that In the performance of thg work for which this permit Is issued, I shall not
M,
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
• 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
r
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, C
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
y )��C�
expiration if work thereunder is suspended for 180 days.
I I
I certify 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, w State,, Zip
r
1 }
E WHITE -FINANCE, PINK -APPLICANT, GREEN :BUILDING, GOIDENR00- ASSESSOR'S OFFICE, HARD GOPY - fILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
rST FL SO FT (a $
UNITS
COLL. AREA
"LAB GRADE/2r Z -<E 57,
ROUGH PLUMB
YARD SPKLR SYSTEM
2ND FL SO FT. gir
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. er
DUCT WORK
ROCK STORAGE
D. REINF./-
POWER OUTLET
ROOF DRAINS
GAR SO. FT. Ca
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
DRAINAGE PIPING
CAR P. SO FT. a
WALL SO. FT. Q
WATER HEATER
DRINKING FOUNTAIN
FINAL INSP.
URINAL
SO FT (a
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.0OOL HOOD
SIGN
WASHER(AUTOYDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
THyG �I
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR @ 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 ELECTRICAL HEATING 8 AIR GOND. SOLAR
SETBACK I
ROUND PLUMBING?
';�' UNDERGROUND
A.C. UNIT
COLL. AREA
"LAB GRADE/2r Z -<E 57,
ROUGH PLUMB
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC 'DANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
D. 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.
f
AMING .i �r 7'�
/// V
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR -
GAR. FIREWALL
THyG �I
Or MESH
�SULATIONISOUND�
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE.SIINITIALS
GARDEN WALL FINAL
city of LaQu'i'nta
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
(760) 777-7012 [FAX] (760) 777-7011
W
W
INSPECTION RECORD
Permit # 9808-002
STRUCTURAL RETROFIT OF UNIT
ADDRESS
DATE
INSPECTION
[YES/NO]
3g
FRAMING/HARDWARE
PLAN TYPE:
INSULATION
Contractor:
WERMERS MULTI -FAMILY CORP.
SHEAR NAILING
/,2 -//- Qg
DRYWALL
JOB FINAL
COMMENTS/NOTES:
MAILING ADDRESS — P.O. BOX 1504 - LA QUINTA, CALLIFORNIA 92253