002851 (RPL)Building 52"6.7 ;L4;da Vi
Address
Owner
D1d lDia" X31
Mailing
Address 1D.0. Box 1064
City Zip
la QLAnta 92253
Contractor
...Address
Sam
P.O. BOX 1504 N U.,
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-303-019
Tel.
564-9222 Legal Description
Project Description I%+ sme.
City .. .. .Zip
SW ft
.. 'Tel_
State Lia
City
& Classif:
Lic. #
Sq. Ft.'' d�
No. No. Dw.
Size
Stories Units
-Arch:; Eng'r.,
Designer
New ,q Add O
• Alter ❑ Repair ❑•. Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
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 full force and,
_ ^
effect.....
1GNATURE DATE
... .. ..
., . .. .'. .. .. - -.
OWNER -BUILDER DECLARATION'
I hereby affirm that I am exempt from the Contractor's License Law .for the following
Estimated Valuation
��+y n,r�e�
22'.0o3o,00
reason: (Sec. 7031.5,Business and Professions Code: Any, city or county. which requires a
- - '
. permit to construct, alter, improve, demolish, or repair anystructure,. prior Wits issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
3 PERMIT '`
- -
AMOUNT
the provisions of the Contractor's License Law, Chapter9 .(commencing with Section 7000) o/
••
Division 3 bf the Business and Professions -Code, or that. he is exempt therefrom, anii'the basis
for Any 'of Section 7031.5 'any
Plan. Chk.. Dep.
^
- the ,alleged ^exemption. violation b)i applicant for. a permit
subjects the applicant We civil penalty of not more than livehundred dollars ($500). '
-
Plan Chk. Bal.
'
i, Q2
. D 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 oroffered,for sale. (Sec. 7044, Buisness and
Const. '^
t3g
s]a
Professions Code: The Contractor's License Law does not apply to. an .owner of property. who
.
builds 0r improves. the.reon and who does such work himself or through his own employees,
Mech.
- ��J.
.provided that such improvements are not intended or offered for sale.. If, however; the building
o00
r improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
- '+'+ 20.00of
proving that he did not build or improve for the purpose o/ sale.) � -,
,
D I, as owner of the property, am exclusively contracting with licensed contractors to con-
.,Plumbing
e
14.00
• structTthe project. (Sec. 7044; Business and Professions Code: The. Contractor's License Law
does not apply to an owner o/ property who builds or improves thereon, and who contracts for
S.M.I.
- `- '.88
- such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
.. ❑ I am exempt under Sec.- B. & P.C: for this reason '
.
Driveway Enc.
�i`^--�•*�i''�-:^��- a ��
Infrastructure
Date Owner ..
WORKERS' COMPENSATION DECLARATION
' I herebyaffirm 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. D Certified copy is hereby furnished.
TOTAL
2s
CERTIFICATE OF EXEMPTION FROM
REMARKS
_. 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.
Dr
NOTICE TO APPLICANT 11, 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 fro:-n..Center Line
Rear Setback fron-Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center.Line '
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.
'5-23-87
I certify that I have read this application and state that the above information is correct:
Issued by:-
Date !�Permit
' 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 propertyzfor inspection purposes.
Validated by:
"
Signature of applicant---:—. Dale 1 -�;--'f-,
Mailing Addresf - ` "
Validation:
City, State, Zip
`%
A 1 6 3
1 L 3 i .�. 3, 4 G N,
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. 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
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
AS (ROUGHIA ) �7 �.
/
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ®c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
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,>�ROUND
PLUMBING/ &
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
//UNDERGROUND
ONDING '� Sr
!/
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
AS (ROUGHIA ) �7 �.
/
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
��. //(✓� k� f2 G o /
l� C
oL
c
t
D y
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
1. D6artment of BUilding.and Safety,
Y
-CITY OF LA OUINTA
TO: 2 Dist.
ADDRESS: `1 -�0/7 �4l/�'C//LG%� ` Date
';CORRECTION NOTICE
Permit No.
F�LociN. �Q� L �V7;FA /AjT® �• Ty: r
GJAV I)ja6i ^�8le—
• ��/Tip//N /O . ,Or4 ,1�Sd . �.4%L. vel' T4 - : � D� - � '
'A ESuL T• /A/
... Inspector .. •
Arrow Printing 250/1=83 w
TA -hp � �a�rw
P.O.BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253 (619) 564-2246
INCIDENT REPORT
ACTION STATUS:
ROUTInE
1. Case Number
SL/
2. Date Reported
3. Time Reported
Hrs.
4. Received by
. fi ,BFoWiV
5. How Received
❑ Via Telephone ❑ Walk-in XSelf Initiated ❑ Staff Referral ❑ Outside Agency Referral ❑ Other:
6. Location of Incident
7. Nature of Incident
�LoCK GvfI�L QeEZ7L� Ont Pl/Bi-IG /2/GqT-o�-(,uf�
8. Name of Reporting Party
� - H • Beow�✓
9. Address of Reporting Party
10. Phone number of Reporting Party
( ) — ❑ Home . ❑ Work ❑ Other
11. Does Reporting Party want contact?.
❑ Yes ❑ No ❑ Optional
12. Assigned to (or) Referred to
❑ Administration ❑ C.S.C. /ZC.E.O. ❑ A.C.Q. kBuilding . ❑ Planning ❑ Other
13. Contract Agency Referral
❑ Sheriff ❑ Fire Dept. ❑ Road Dept. ❑ Health Dept. ❑ C.ther
14. Description or Additional Information
15. Vion Taken (initial)
viM2 __606-180T- 6 ,J _r -b C' , o„i
16. Case Status after initial.action
❑ Closed 'WOpen - Reason: �f�l/27�N� /C J %ICTIO�
17. Action Taken (follow up)
18. Case Status after follow-up
❑ Closed ❑ Open - Reason:
19. Legal Action Taken
❑ Citation issued ❑ Referred to City Attorney ❑ Other
20. Evidence / Photos / Other Documentation
4
21. Total City Time used to handle incident
Hrs. + Hrs. = Hrs.
22. Estimated Cost to handle incident
$ + $ + $ _$
23. Person assigned to handle case
24. Title or Position
25. Date case closed
Reviewed by
12-83
Case Number Date Reported Person Assigned to Case Title
f #t
HV 't
❑ Additional Information ❑ Supplemental Report ❑ Narrative