08971 (SFD)• •44
C ti
P.O. BOX 1504' /~ N o . 0$ 971•
Building 78-105 CALLE ESTADO
Address 78-975 ladJAM tovddCoUt• LA QUINTA, CALIFORNIA 92253
ti
Address 35* j n S
City I Zip
Contractor
Address
Zip I Tel.
State Lic. I City
& Classif-• 4126M Lic. #
Arch., Engr.,
Designer
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 fu/lyforce and
effect. JrYr i✓`i.r!`� ;T/,/' e!NI'.,�i_';ri�.'S
SIGNATUR '6' ,r' - -. ^_. .:.dt r f ,r;
DATE
OWNER -BUILDER DECLARATION ir
I hereby affirm that 1 am exempt frbmsAITP;Contractor's License Law for the following
reason: (Sec. 7031.5,Business and. Professions Code: Any city or county which requires a
permit to construct, alter, 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
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
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 -T
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.
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., It, 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 if 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description a HIMS
Project Description J5MA*1 4n gam± 14
Sq. Ft. No. No. Dw.
Size 3017 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep" •
Distances:
Plan Chk. Bal.tj
Front Setback from Center Line
Const.
Rear Setback from Rear Prop. Line
Mech.
Side Street Setback from Center Line
Electrical
01
.Plumbing
FINAL DATE
S.M.I.
15.13
Grading
Validated by:,
Driveway Enc.
Infrastructure
14922.12
TOTAL
REMARKS
.-727.0.17
Y4y'""9'A ��t�1 t�� 4 �_..YYM1 Jx�
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. ® $
2ND FL. SO. FT.
POR. ' SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEGUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Vic
HOUSE SEWER
REMARKS:
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
BACK
ROUND PLUMBI
I UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 40 —15'- 9U
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
�p
EWER GR-6EPTt�T V
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
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.
U ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
MODEL 4AR LOT 14 UNIT 103
CITY OF LA OUINTA
*OFDEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
564-2246
24-HOUR NOTICE FOR INSPECTIONS
Owner M. J. BROCK
Contractor M • J. BROCK
Permit Number 08971 .
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-975 Indian Wood Court
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
ROUGH PLUMBING
FOOTING STEEL
-
MAIN GROUND SYSTEM
HEATING & VENT- A/C
GROUND PLUMBING
FIREPLACE
PRE-GUNITE
ROOF
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
/0—/5'
JOISTS & GIRDERS
— L
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
( 4- o
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
— L
GROUT 0 4' O 8'
FRAMING
-C11 I AU -e
INSULATION
PRE -ROOF
COVER NO WORK UNTIL A Off
HAS BEEN SIGNAD
DRYWALL INTERIOR
EXTERIOR LATH
�(
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC'TANfC %v / - 9v AA
FINALS
JVO I,VMr'Lt I tU I
TFMP Pr)%A/FR
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING