09339 (SFD)Building
Address 7A»
Owner
M. .T._ 1
Mailing
' u
P.O. BOX 1504
78-105 CALLE ESTADO
!A r—In4?ATP
LA QUINTA, CALIFORNIA 92253
City lZip ITO
Contractor
Address
State Lic. - I City
& Classif. B 412636 Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
r s LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,l am;licensad,under provisions of Chapter 9 (commencin`g with Section
7000) of Division 3�of the'B�siness and Professions�Code; and my license�lg in full Bice and
C— 5MGNATURE' _ -` .✓ .f' "" - / i' / 1 f J DATE
OWNER -BUILDER DECLARATION
f I hereby affirm that I am exempt from the Contractor's License Law for the following
-reason: (Sec. 7031.5,Buslness 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 /or 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) o/
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 o/ not more than live 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 improve ant is sold within one year of completion, the owner -builder will have the burden
i . of proving thmat he did not build or improve /or the purpose of sale.)
I
❑ 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 /or
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
I ❑ 1 am exempt under Sec. B. & P.C. for this reason
i
j, Date Owner
WORKERS' COMPENSATION DECLARATION
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.
Dale Owner
NOTICE TO APPLICANT: If, after making this Certificate o/ Exemption you should become
subject to the Workers' Compensation provisions o/ 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
i 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.
Icertify 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 -
men property for Inspection purposes.
Signature of applicant Date
I, Mailing Address
City, State, Zip
I _
No. 09339
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description Rrnf!k Romp
Project Description Memm-oi 2AR T^#- ASS
.
�txt�hi WA 44k49All e.r1M�•e3�!�•.•�fi
ZONE:
BY:
Sq. Ft.
Size 22'R3
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
t
FINAL DATE
INSPECTOR
Estimated Valuation
9 � _fidl
PERMIT
AMOUNT
Plan Chk. Dep.
Validation:
Plan Chk. Bal.
624.91
Const.
874.00
Mech.
71.00
Electrical
123, AS
Plumbing
S.M.I.
I
Grading
Driveway Enc.
Infrastructure
3747.56
$ In 011b
_
166-40
TOTAL
S7 75-91
REMARKS
.
�txt�hi WA 44k49All e.r1M�•e3�!�•.•�fi
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 i
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. S0. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CARP. SQ. FT.
TEMP. POLE
WALL SD. FT.
GROUT
DRINKING FOUNTAIN.
SQ. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WAII ER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
MESH
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
ROCKSTORAGE
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.
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
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Model 2AR Lot 45
a/
CITY OF LA OUINTA
�•Of ~ `y DEPARTMENT OF PLANNING & DEVELOPMENT
BUILDING DIVISION
5642246
24-HOUR NOTICE FOR ff 5F(a1$*A
Owner M. J. Brock APR U � 1991
Contractor Same F
Permit Number 9339
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-835 Grand Traverse Ave.
TYPE OF INSPECTION I DATE I INSP.
FOUNDATION & SETBACK
FOOTING STEEL /
MAIN GROUND SYSTEM F_
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
BOND BEAM
O.K. TO WRAP Cj
GROUT ❑ 4' ❑ 8'
FRAMING i-1 7 -G I Ll
PRE -ROOF I I
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
4188