003458 (SPIN)44
P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 51"'443 AV MDA VALL= LA QUINTA, CALIFORNIA 92253
Owner
-mailing . -
Address SAM
City
LA, QUOTA
Contractor.
KM Fe COL -14M JRo e
_ .. BUILDING: TYPE CONST. • OCC:;GRP.- S -
A.P. Number
Zip Tel. -
-92253 56691 Legal Description
Project Description 4s`.LABGZ.�I� INUE-CA OF
-City .
Zip
Tel..
State Lic.
City
& Classif..
Lic. #
Sq. Ft. - '
No. No. Dw.
Size -
Stories - Units
•
..Arch.; Engr.; .. - ... _.
• Designer
New ❑' - Add ❑
Alter ❑. Repair ❑ :. 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'
effect.. ... .
.. .. _ .. ...
.. ... .. -
• SIGNATURE DATE
OWNER -BUILDER DECLARATION
hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec, 7031.5, Business and Professions Code: Any •cNy or•coyrty -which requires, a ,-
i.. permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
-requires the applicant for such permib.to file a signed statement that he is licensed•pufsuant 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
EStlmated, Valuation
-
-
-
PERMIT
,AMOUNT --•
Plan.Chk. D.ep..'
•
-
Plan Chk.. Bal.
-
Const.
- o
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 npt appy to,an_owner of property who..
-Mech. -
-
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
Electrical
or improvement is sold within one year o/ completion, the owner -builder- will have the burden
of proving that he did not build or improve for the purpose of sale.). -
Plumbing
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.-
-such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ I am.exempt under Sec. B. & P.C. for this reason -
Grading
Driveway Enc.
Dale 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,.. .O.Ceitified copy is hereby furnished.-
TOTAL
_
CERTIFICATE OF EXEMPTION FROM r
WORKERS' COMPENSATION INSURANCE
REMARKS
(This section need not be completed if the permit is for one hundred dollars (8100) valuation
- or less) .. . ._
1 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.
c s-- y, rr
�'• >,; - t •q } c ` "t ^_
t � `'
�-
• - -
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
,'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
FINAL DATE, "'
Issued by:
Validated by:
INSPECTOR-
Date 10/39i_g/Permit
.
Lender's Address
' .This'is a building permit when properly f:lled'out; signed and validated; and is subject to
expiration if work thereunder is suspended for 180 days.
I•cerlify.thatl have read this application and state that the above information is correct:.
` I agree to comply with all city and county ordinarices and state laws relating to building
construction, and hereby authorize representatives -of this city to enter theabove-.
mentioned property for inspection purposes.
Signature of.applicant Date
Mailing Address,.
Validation:'•
City, state, zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
F
2ND FL. SQ. FT. p
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN
SQ. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
JITEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
t SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
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.IEQUIP.
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING -
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
.FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS.
GARDEN WALL FINAL
78 105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 (619) 564-2N6
October 22, 1987
Mr. William F. Colwell, Jr.
51-443 Avenida Vallejo
La Quinta, CA 9225;3
Dear Mr. Colwell:
A special inspection was conducted.at.the above address on 10/20/87.
Although no permits were pulled prior to the construction of the room
addition, it'does comply with current setback, natural light,
ventilation and exiting requirements. The addition appears to.be
structurally sound.;
If you are in need of further .information`or additional
certification, please do not hesitate to contact the undersigned.''
Very truly yours
TOM HARTUNG
BUILDING OFFICIAL
PLANNING & DEVELOPMENT DEPARTMENT"
TH:bja
i.
ltrth.103 .
MAILING ADDRESS P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253