11010 (RER)ti
,o
Building
Address 53-040 Eisenhowe
Owner
Dennis Burkett
Mailing
Address 53040 Eisenhower
cvuinta Izip32153
Contractor
.Owner/Builder
ress.
City lZip .
P.O. BOX 1504
Drive
7&105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Tel.
564-3522
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
i 7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION.
I 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 We a signedstatement that he is licegsed,,puisuant..to
the provisions of the Contractor's License Law, Chapter 9 (commencing wit *Section„7000)-of
Diftion'3 of the Business and Professions Code, or Met. he is exempt th f>� irp Merbasis
for the -alleged exemption. Any valation of Section 7031.5 by 'any Ac /i7pi a permit
subjects the applicant to a civil penally of not more than five hundred dollars ,(850QQ)
es
q I, as, owner of the property, or my employees with wagas their sole ciSmpensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractors License Law does not apply -lo 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
orimprovement 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 contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under
Sec ,& P.C. for this reason
Date Owner /.YtW; X�tf lel-77— „l fir 1— 44.
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 fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be comm teted if the pemdt is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ anyperson in any manner so as to become subject to'the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: N, after making this Certificate of Exemption you should become
subject to the 'Workers' Compensation provsions of the Labor Code, you must 'forthwith
comply with such provisions or this permit shad 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 property 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 411 -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
.-r
No. 11010
BUILDING: TYPE CONST., OCC: GRP.•
A.P. Number 774--061.-002
,Legal Description
Project, Description Remodel
Sq.
emfldel
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ .
NOTE: SUPPLEMENTAL PE -11T - PEES PAID
ON PERMIT 4003019
Estimated Valuation
22183.00
P_ERMIT AMOUNT
Plan C
Plan. Chk. Bal.
Const. '
Mech..
Electrical
ti
Plumbing
S.M.L
Grading
Driveway Enc.
Infrastructure
TOTAL ^3~
REMARKS
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
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
A.C. UNIT
COLL. AREA
SLAB GRADE
ZT FL. SQ. FT. ® $
UNITS
HEATING (ROUGH)
2ND FL. SQ. FT.
FORMS I
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. SO. FT. ®
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SO FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FRAMING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD,
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
MESH
SQ.FT.GAR @ 3/<c
HOUSE SEWER
INSULATIONISOUND
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
74-9
GROUND PLUMBING 7 ;
A-
P
NDERGROUND Ob
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS I
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.
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 SIGNATURES/INITIALS
GARDEN WALL FINAL
T4ht
"
78-105 CALLE ESTADO — LA QUINTA, CALIFORNIA 92253 - (619) 564-2246
FAX (619) 564-5617
May 26, 1993
Dennis Burkett
53-040 Eisenhower Drive
La Quinta, CA 92253
Dear Mr. Burkett:
It has come to the attention of the City of La Quinta Department of
Building and Safety that your building permit number 3019 at 53-040
Eisenhower Drive has expired.
According to the Uniform Building Code, Section 303(d), no further
work shall be performed on the above permitted job -site until a new
permit has been issued or an extension granted. An extension of
this permit can be requested in writing within 14 days. of the date
of this letter.
If a final inspection has not been requested due to an oversight by
either yourself or your contractor, please schedule that final
inspection within 14 days to resolve this matter. Failure to do so
will result in further action by the City.
Please contact me at your earliest convenience.
immediate attention to this matter.
Sincerely,
BU DI AND S TY DEPARTMENT
Lonnie Day
Building Inspector
kt
Attachment
We appreciate your
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253