12528 (RPL)Building 54-350 Herrera
Address
Owner Jack Clark Jr.
Mailing
Address 54-065 Herrera.
City Zip
La tuinta, C 92253
Contractor
Jack Clark Jr.
Address
TRY
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
City Zip Tela
State Lic. City
& Classif. 506667 Lic. # 1115
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
i LICENSED CONTRACTOR'S DECLARATION
I hereby..affirm that I am licensed unde§ Provisions -of Chapter 9 (commencing with Section
1000) of Di.'vision 3Sof the Business and Professions Code, and my license is in fulllforce and•
ffectt., f t f if /� `{ t,,i r 1k pi ' f !¢ . - � • i
K.
SIGNATURE c DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 penalty of not more than five hundred dollars ($500).
❑ 1, 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 build or improve for the purpose of sale.)
❑ 1, 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
D 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.) e
I certify that in the performance of the work for which this permit is issued, I shall not
employ any, personjin any manner so a's to become subject to the' Workers' Compensation
Laws of California.){, ,-. � t 1j t J f, .
Date!"' in
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
I comply with such provisions or this permit shall be deemed revoked.
.ti
CONSTRUCTION LENDING AGENCY
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 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
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST
A.P. Number
Legal Description
Project Description gaol
No.
OCC: GRP._
32528
ZONE:
BY:
Minimum Setback Distances:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New Ej Add ❑
Alter ❑ Repair ❑ Demolition ❑
i Side Street Setback from Center Line-= '
Side Setback from Property Line + `
FINAL DATEIN'S'PECi
Issued by:
Date Z- Pe7mit Li INI
Validated by:
f+w"f111 `A 1Qgl
Estimated Valuation
$80,000.00
PERMIT
;AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
64.35
Const.
99.40
Mech.
24.00
Electrical
45.00
Plumbing
27-00
.S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
259.35
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Im-- ReaPlSetback from Rear Prop. Line �
i Side Street Setback from Center Line-= '
Side Setback from Property Line + `
FINAL DATEIN'S'PECi
Issued by:
Date Z- Pe7mit Li INI
Validated by:
f+w"f111 `A 1Qgl
Y Y iY
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEE_!
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. p
GAS (ROUGH)
METER LOOP
GAR. SO. 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
BOND BEAM
WATER SYSTEM
URINAL
SO. FT. ®
=$
LUMBER GR.
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
-93
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIRE
FIRE ZONE ROOFING
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIREPLACE
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 APP.IEOUIP.
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
-93
REMARKS:
VENTILATION
FIRE
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
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
December 16,1997
Jack :Clark Jr.
54-350 Avenida Herrera
La Quinta, CA., 92253
RE: Pool Permit #12528
Dear Mr. Clark
The purpose of this letter is to inform you that your Pool Permit #12528, for the project at
54-350 Avenida Herrera, has expired. In accordance with 1994 UBC section 106.4.4,,no
further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I; at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any 'required inspections. Should you.
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Buildi g & Safety Manager
Daniel P. Crawf rd J
Building Inspector I
cc: file
dpc
MAILING ADDRESS - P.O. BOX 1504 - LA OUINTA, CALIFORNIA 92253 �J
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