06880 (BLCK)T4hf
P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 52-615 Diaz LA quINTA, CALIFORNIA 92253
Owner
Mailing
Address ser .,
City Zip Tel.
. I La Qtainta 92253 .
Contractor
Address
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City' Zip State
Lic: #
ucbmm CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
effect
of Division 3 of the Business and Professions Code, and my license is in full force and
effect w ,
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec., 7031.5,8usness and Professions Code: Any city or county which requires a
permit to construct, after, irprove, demolish, or repair any structure, prior to its issuance also
requires the vpb=f for such pemu7 to bile a signed statement that he is licensed pursuant to
the provisions of the Contractors 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
tot the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a chill penally o/not more than five hundred dollars ($500).
❑ 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 Wald 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 contracts for
such projects with a cont actors) 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
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
❑ Copy is filed with the city- O Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollars (S I00) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ anyppeerson in any manner so as to become subject to the Workers' Compensation
Laws of CaliF
Date Owner
NOTICE TO APPLICANT, h, 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.)
Lenders Name
Lenders 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 certity 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 abovem
mentioned property for inspection purposes.
Signature of applicant Date
.Mailing Address
City, State, Zip
BUILDING-. TYPE CONST: •
A.P. Number 7731-381-x!18
Legal Description
Project Description 1251 X 61
OCC: GRP.-
wood fence
ZONE:
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
• Date 1/17/90 permit
Validated by:
Estimated Valuation
$1,062
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
445.00
Mech.
Electrical
Plumbing
S.M.I.
.14
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
t!sy�n
�. ..... Cfi 3 rL i �,. 3. 4:). 1'q
Validation:
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 1/17/90 permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. Sp, FT. ®
POWER OUTLET.
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. ®
GROUT
WATER HEATER
WALL SO. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING:
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
LATHING
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
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 . 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
t•
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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL
T4t�t
W "
- - ,
78-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
FAX (619) 564-5617
December 6, 1991
To Whom It May Concern:
The structure located -at 52-615 Avenida Diaz is located in
an "X" flood zone (Areas of 500 year flood; areas of 100
year flood with average depths of less than 1 foot or with
drainage areas less than 1'square mile; and areas protected
by levees from 100 year flood) per the revised F.I.R.M.
(panel 060709 0005 B, effective August 19, 1991) for La
Quinta.
If you have any questions, feel free to contact me.
Sincerely,
lBUIL�DING AND SAFETY
Tom Hartung
Director of Building and Safety
TH/lc
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253