14385 (RER)t� . �.� . lit/•
`a P.O. BOX 1504 No., 14385.
Building�$�� C"J�.C�2 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner John Carper
Mailing 'SaXW
Address
.City Zip Tel. " '
44a. Quinta R . CA 92
Contractor.
Addie ..
o dog 97'7
"La Qu .nta' ,dA`I`'92253 r7
.772-4024 -
State Lic. City
& Classif. , B 61;,96$0 Lic. # 2231.
Arch., Engr.,
Designer
Address Tel.
City Zip State
A Lic. #
/� . • . LICENSEDfC TRACTOR'S DECLARATION•
I hereby, firm that I am licensed un�d.''er provisions of Chapter 9 (commencing with Section
7000) of Di is
3 of the Businessland Professions Code, and my license is in full force and
effectfl
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Garage Convers-ion
Project Description
Sq. Ft. No. No. Dw.
Size• 224. Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑. Demolition ❑
Date owner 1
WORKERS' COMPENSATION DECLARATION '
I her ffiim that I have a certificate of consent to self -insure, or a certificate of
Worker's Co pensation Insurance, or a certified copy thereof: (Sec: 3800, Labor Code.)
v PoIIcY N9 Company
_l3opy Is filed with the city. . O Certified copy is hereby furnished.
V. 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,-[ shall not
'employ any p -
Laws of Califeornirson in any manner so as to become subject to the Workers' Compensation a
Date Owner -
REMARKS
AMOUNT
i MOO
• t;)a iYYi
144
6
r
6
NOTICE TO APPUCANT: ff,' after making this Certificate of Exemption you should become ZONE: -. BY: 1 ! I! -
subject to the Workers' Cohoensation provisions of the Labor Code, you must- forthwith
comply with such provisions or this permit shall be deemed revoked: . ' ' Minimum Setback Distances: -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO. ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE'LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days..
I per 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.
Signature of applicant Date
.Mailing Address
City, State, Zip
Front Setback from Center Line
Rear Setback from Rear Prop. Line
s' Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
&IGNAT OWE _ - tY. DATE
' OWNER -BUILDER DECLARATION
Estimated �/alUatl(
1 hereby affirm that 1 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
Permit to construct, after, improve, demolish, or repair any -structure, prior to its issuance also
requires the applicant,for such permit to rile a signed statement• that he is licensed pursuant to
PERMIT
the provisions of the'Contractor's License Law, Chapter-or9 (commencing with Section 7000) of
�••
Division 3 of the Business and Professions Code, that he is exempt therefrom, and the basis'
for thealleged exemption. Any Section 7031.5 'any,
-
Plan Chk. Dep.
violation. of .by applicant for a permit
subjects the applicant to a civil penalty of not more than rove hundred'dollars ($500). -
-
❑ I, as owner of the property, or my employees with wages -as their sole compensation, will
Plan, Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044,'Buisness and
COr1St:
Professions Code: The.,Contractors� License Law does not apply to an owner of property who .
builds or Improves thereon and who. doessuch work himself or through his own employees, -
Mech.- '
providedahat 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 Inprove for Ne purpose of sale.) ,
O 1, as owner of the property, am exclusively contracting. with licensed contractors to'con-
Plumbing
slruct the project. (Sec. 7044, Business and -Professions Code: The Contractor's License Law.
does -not apply to an owner or property who builds or improves thereon, and who contracts for
S.M.I.
such projects with a contractors) licensed pursuant Yo the Contractor's.License Law.)
.
Giading
❑ I am exempt under Sec. B: 8 P.C. for this reason
Driveway Enc.
Date owner 1
WORKERS' COMPENSATION DECLARATION '
I her ffiim that I have a certificate of consent to self -insure, or a certificate of
Worker's Co pensation Insurance, or a certified copy thereof: (Sec: 3800, Labor Code.)
v PoIIcY N9 Company
_l3opy Is filed with the city. . O Certified copy is hereby furnished.
V. 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,-[ shall not
'employ any p -
Laws of Califeornirson in any manner so as to become subject to the Workers' Compensation a
Date Owner -
REMARKS
AMOUNT
i MOO
• t;)a iYYi
144
6
r
6
NOTICE TO APPUCANT: ff,' after making this Certificate of Exemption you should become ZONE: -. BY: 1 ! I! -
subject to the Workers' Cohoensation provisions of the Labor Code, you must- forthwith
comply with such provisions or this permit shall be deemed revoked: . ' ' Minimum Setback Distances: -
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO. ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE'LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days..
I per 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.
Signature of applicant Date
.Mailing Address
City, State, Zip
Front Setback from Center Line
Rear Setback from Rear Prop. Line
s' Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW%3 FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. ®
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK `
GAR. SO, FT. ® `.., ,;`
POWER OUTLET
ROOF DRAINS
CARP. SO. FT. ®. ` '
FOUND. REINF.
DRAINAGE PIPING
WALL SO. FT. ®,
HEATING (FINAL)
DRINKING FOUNTAIN.
SO., FT. ®
GAS (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN
MECHANICAL FEES
BOND BEAM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD-
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE, UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
)n
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 ® 11/a c
SEWAGE DISPOSAL
GAR. FIREWALL
LATHI G
SO.FT.GAR ® V4c
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 ' ' ' EfTRICAL HEATING & AIR COND. SOLAR
M
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
+FINAL INSP.
BOND BEAM
WATER SYSTE
.GRADING
cu. yd.
$ plus x$'
_$
LUMBER GR.
FINAL INSP ,7,�
FRAMING
FINAL INSP.
ROOFING
)n
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHI G
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
-t-&' eAk�/
V
Tri
Orr Tr -s.. _
Tit�r ui 149a 011hita
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
BUILDING ADDRESS 78-765 Irwin Circle
Use Classification Garage Conversion Bldg. Permit No. 14385
Group R3 Type Construction VN Fre Zone Use Zone cR
Owner of Building John Carper Address 78-765 Irwin Circle
Citv La Qui ta, CA 92253
By: Bruce Pelletier
Date;December 28, 1994
Building Official
POST IN A CONeTICUOU! 'LACE
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