003466 (SPIN)P.O. BOX 1504
OCAddress 96x&0 Jefferson Street -LAQUINTACAL FORNIA 92253
_
Owner
E.
mailing
Address Same
City Zip
Contractor
Address
•City _ . ._ IZip
State Lic.
& Classif.
-Arch., Engr:;
Designer
Address
No. 003466
rin BUILDING: TYPECONST.• OCC: GRP.
A.P. Number
..Tel. -.
-, Legal Description
Project Description ^rt
City
Lic. # Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition O
Tel.
City
Zip
State
WORKERS'COMPENSATIONINSURANCE {
. . . ..
_ .
Lic. #
µ
LICENSED CONTRACTOR'S DECLARATION _
or less.) -•• -•
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
_
OWNER;BUILDER DECLARATION "'
I hereby affirm that I am exempt from the Contractor's License Law for the following
. reason: (Sec.. 7031.5, Business and Professions Code:. Any city or county which requires a .
• - employ any person. in any manner so as to become subject to the Workers' Compensation
of California
Estimated Valuation
'
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 .
PERMIT.
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 allegedexemption. Any . violation of Section 7031.5 by 'any applicant for a permit
-t' •'
Plan- Chk. Dep. -
-' subjects the applicant to a civil penalty of not more than five'hundred dollars ($500).
0 I, as owner of the property,. or my employeeswith wages as their sole compensation, will
do the work, and the structure is not intended . or offered for.saje. jSec. 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
Plan Chk. Bal.
Const.
Mech.
' Electrical '
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.)
Plumbing-
❑ 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 -
S.M.I.
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.)
0 I am exempt under Sec. B..& P.C. for this. reason
Grading
Driveway Enc.
at rrl,+ft •7 owner r-ro.4+w.._-
Infrastructure
Side Setback from Property Line
Lender's Name
WORKERS' COMPENSATION DECLARATION
' I hereby affirm'that'l have a -certificate of consent to* self -insure, or a certificate of
INSPECTOR
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
' Policy No.' company
expiration if work thereunder is suspended for 180 days.
❑ Copy is filed with the city. _ ❑ Certified copy is hereby furnished.
TOTAL
Issued by:
AMOUNT
. sloo. eo
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'COMPENSATIONINSURANCE {
(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
of California
4r i tdJt9 J 1 i? C ttY. 1 d+. tin= VVLaws
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
Side Street Setback from Center Line
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 Setback from Property Line
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
expiration if work thereunder is suspended for 180 days.
I certify that,l have read this application and state that the above information is correct.
Issued by:
_ _
Date liD123'`111 f?ermlt
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FIES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ. FT. @
CAR P. SQ. FT.
WALL SQ. FT. @
SQ. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
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
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
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
I
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
moi•
78-105 CALLE ESTADO - LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
October 27, 1987
Mr. Thomas E. Spurgin
46-480 Jefferson Street
La Quinta, CA 92253
Dear Mr. Spurgin:
A special inspection was conducted at the above address on 10/26/87.
The area of concern was a garage that had been converted into a
bedroom. There is no record of a permit being obtained.
The inspection revealed that no structural alteration had taken place
and the room complies with current standards for natural light and
ventilation, emergency egress, and room dimensions. The bedroom does
not appear to present a threat to the life safety of the inhabitants
of the dwelling.
If there are any further questions or if you need further assistance,
please contact the undersigned.
Very truly yours,
Tom Hartung
Building Official
TH:bja
ltrth.105
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253