9925 (ELEC)4
P*—
DEL MONTE CT. P.O. BOX 1504 ( No.
Building78e9$O �8�$ 78-105 CALLE ESTADO _� t
Oririrocc LA QUINTA, CALIFORNIA 92253
Owne BROCK HOMES
Address 3350 SHELBY ST.,
cityNTARIO, CA Zip 9176
iait—�H$3g�! 93393 j
Contractor
STE 100
1.48945-1155
TEMPORARY UTILITY SERVICES
Address
1325 ST, ANDREWS PL
City Zip Tel.:
SANTA ANA 192705 662-2525
State Lic. City
& Classif. 523596—C61 Lic. # 1881
Arch., Engr.,
Designer
Address
City
Zip (State
Lic. #
-_1 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Divi ion 3 of the Business and Professions Code, and my license is in fullforceand
y effect. �y4.>.v >�. ,:.� ._ s5
SIGNATURE DATE
i
OWNER -BUILDER DECLARATION
1 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
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 penally of not more than five hundred dollars.($500). '
❑ I, as owner of the property, or my employees with wagesas 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.) .
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 contractsfor
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
O 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
WorkeP.s Compensation Insurance, or a certified copy.fthereof..(Sec. 3800, Labor Code.)
' 1 =
Policy°No. Company . t { J�°7. •.r^ l
�[11 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 parson 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 1 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
9925
T B14P
BUILDING: TYPE CONSTPOLE OCC: GRP.
A.P. Number
Legal Description
Project Description TEMP POWERPOLE
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑' Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical 530.00
Plumbing
S.M.I.
Grading
Driveway -Enc.
Infrastructure
TOTAL§JU.OU
REMARKS
r.w: •-.n r n nr•i �•. .+sew a rx,� � r'�y
Ila t '10100
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 Permi
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CAR P. SO. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
r
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
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 ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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 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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -plus-x$_=$
LUMBER GR.
INSP.
FRAMING
FINAL INSP.
ROOFING
r
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
J U L— 1 4— 9 2 T U E S:119—MARQUIS MANAGEMENT P_01
MaNaG�M�nrT vGRauP
3$.975 Date Palm Drive, Suite 200
Calwrat City, California 92234
(619) 324-7700 • FAX (619) 324-1908
DESERT FAIRWAYS
A�tCU1TECTUR.AL VARIANCE AUTHORIZATION
NAME Thomas 6 Charlotte Greene
ADDRESS 75980 Del Monte Court, La Quinta, CA.
Your request for Architectural Variance has been approved
by the Architectural Committee. Any changes requiring a
Building permit must be obtained through the City and must
pass any City Inspection. All changes must comply with City
and County Codes.
SPECIAL NOTES Please submit copies of all City Permits
and Final Inspection capon receipt.
Thank Aou,
NanLjv'Due
Account xecutive
REGIONAL OFFICES
Irvine a Rancho Cucamonga m San Clemente a South Bay . COachetla Valley c Son Diego