08969 (SFD)P.O. BOX 1504
Building 78.105 CALLE ESTADO
Address 78-990 Ittdim good COtwt LA QUINTA, CALIFORNIA 92253
Owner
Address n a�
City � ftp Tel.
A
Cont
Address
City Zip I Tel.
State Lic. City
& Classif. 412636 Lic. # 233
Arch., Engr.,
Designer I
Address Tel.
CityI Zip I State I
Lic. #
arCj�.I hereby affirm thaPl am licensed under provisions oGChapter 9 (commenc
_7000) of Division'3 of the'Busipess and Professions Code, and my license is
effect. s j.tt 1 / -
OWNER-BUIL•DER-DECLARATION { r
I hereby affirm that I am exempt from�thgvContractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
.Apermit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
? erequires the applicant for such permit to 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
r 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
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
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.)
❑ 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
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
Date owner
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.
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 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.
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.
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.)
Lender's Name
Lender's Address
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.
I 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.
Signature of applicant Date
Mailing Address
City, State, Zip
N o . 08969
LDING: TYPE CONST. OCC:•GRP.
P. Number
Legal Description BR= am=
Project Description 3' Mewl ACR t,n; 12
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
.New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$218,761.00
- PERMIT
AMOUNT
Plan Chk. Dep.
i
Plan Chk. Bal.Q
,
Const.
Mech.
Electrical
c1 !
Plumbing
180 so
S.M.I.
3
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Ili f .i"tEk'r..f
`" i "9" t,n rid
air ♦,ea,x r r a r
as.:.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
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. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
L /'SAS (ROUGH) _ v1 METER LOOP
DRAINAGE PIPING
WALL SO. Ff.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
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.000L HOOD
SIGN
WASHER(AUTONDISH)
APPLIANCE DRYER
AMING 7-1-11-4rl
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OCL , V L</ C -q/9
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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 ® 1+/. c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/.c
HOUSE SEWER
MESH
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 & AIR COND. SOLAR
SETBACK
94
ROUND PLUMB[ N� UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
ORMSSEWER
— ROUGH WIRING
DUCTWORK
ROCKSTORAGE
FOUND. REINF.
L /'SAS (ROUGH) _ v1 METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
—Plus—X$—=$
LUMBER GR.
INAL INSP.
AMING 7-1-11-4rl
FINAL INSP.
4ROOFING
OCL , V L</ C -q/9
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
&�INSULATIONISOUND3' '
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
t GARDEN WALL FINAL
MODEL 4CR Lot 12 Unit 103
i'
d
CITY OF LA OUINTA
`dor F `y DEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
5642246
24-HOUR NOTICE FOR INSPECTIONS
Owner M. J. BROCK
Contractor M. J. BROCK
Permit Number 08969
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-990 Indian Wood Court
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING -f-"d
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS SEEN SIGNED
CONCRETE SLAB - - n
JOISTS & GIRDERS
ELECTRICAL GROUNDWORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST L ( `>
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT O 4' 0 8'
FRAMING - -
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABO E HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH -
POOL PRE PLASTER
POOL FENCE & GATE
SEWER
FINALS
ELECTRICAL 3 Gt L-10
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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