12778 (BLCK)4
P.O. BOX 1504
Building 80-8110 Vifita ROnita 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Jack & Shirloy McGinty
Mailing
Address P.O. Bon 1767
CityZip
Tel.
La Quinta, C,
92253
347-4245
Contractor
Precision Masonry
Addr:b. Box 3938
city Palm Desert,
Jz& 92261
Tel '345-9716
State Lic.
& Classif. 472848
City y
Lic. #
Arch., Engr.,
Designer
Address
Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
lot of Division 3 of the Business and Professions Code, and my license is in full force and
effec
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, after, 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 thathe 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).
❑ 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, euisness 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 pr ving that he did not build or improve for the purpose of sale.)
as owner of the property, am exclusively contracting with licensed contractors to con-
st u Pihe 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.)
O 1 am exempt under Sec. B. & P.C. for this reason
t r
`Date !:t 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 Ccde.)
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 it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the 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.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you shou�d 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
Ihereby 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 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
No. 12778 t
l
_OCC. GRP.
300 1,f. of 6' high block wall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
i
Estimated Valuation $7,500.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. . UU
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 99 UU
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street SelbaQk from Center Line
Side Setbac (fTpm Prl;,q,gy Line
FINAL DATE
Issued by:
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND.; L. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
POF'. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEQUIP.
DRAINAGE PIPING
CAR P. SQ. FT.
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED.CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to 6e used as property tax valuation
=$
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
VENTILATION
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.
SQ. FT. ® c
BATH TUB
GAR. FIREWALL
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
I 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.' G
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
L,A QUINTO
e/Q F ORTIM WEST MA$AQEMEN T
a E.- WI .Ixpa COWA14Y
r • 13.904 81 Pasco, Suite 1(k4DAr)
l�ilui Dciert, (:alit'oruia 97260
(619) 346-8052 FAX (619)'779-13'70
POLO ESTATES. ASSOCIATION
ARCHITEC.. r- URAL APPLICATION'
lli�ll'k":, Dit1��S:. 5,! O C� (/,�7A �o �/i7•�J %�2� / L _ W� DATB / < ��
SAIL} v ; nUt)R .45 U • :t'� �c / 19 ct� X74 PHONE,
MWARI ATIUI`Tl;;SQM^siY ; NSt .�. �� Q,�✓ , 0 1� eo•J7
Architectural P cviow Committee:
Tou aro hereby agvlst4 tbitt the ro1lowb;kw9xkls ptgposed and opprbv;tl•is requested. Attached run thedrawiiigs of tho work to hr
done and jhe types of riatci6ftls tb bo used arvbidicoted on the drawin1is.'We uridorstood that building permits Par home (nipeoveme.nts of;y
bc.> �Viiu by tho City 1( Lzk:.CYijn14.%iid thRt.tho cost of the peritijta and the responsibility of obtaining permits and subsegucnt inspccdous
wW'be burs by t v itpphcli'tit.
WC ytil(ooivtod c'¢hat ' t a coved than os bi the ori nal dcsl will be at our expense, that any drama o to or rotocatiou of
g � hl• .8 14i !� pe Y 8
rmisc1 g,ii iu!clor systen�s, t a¢ar rouuti.utiiit7cs, building structure and oxtedorlandkaping or other damage resulting from ilia coustruotiou
of tEjrtcY; nrii.ttbd jr�provuiil�ntsslialZb� at our expense; arid, the maintceanco-of•tt;e'pennitttd •improvoniccits stnandl beat our expcnso.
11Vc also that the conslructi.ou of than requdsted and approved niod.jJ1cal1ons inust begin within thirty (30) days o1• our
rwoijitbf rMuu 4pprovt�4iid that iaidnpproved 63odifiealion3 must be cumploted within sixty (60) days of the receipt of written iipprovi:l.
Faititiv io Cti�tSly With llies9 *1r tiny of thcabovE specifications, or 3peeiticdtions oudincd'within the Assoeiatio.n's gover tilag doCUniell LS wi1I
rc3ult inaiw �wUifis•wd0r;-1)614ccu goat said subsequent approval thoreot'.
UW1�f1It: �' l /. inJ-r � 9IGNATURE: � ............—.---
. (p!c;uc print)
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abt;vii.AgUeawd cioditier+tiou has been reviewed by the Architectural Review Couuuitteo uadh s been:
AP11R.0YI',)) ._,. 1t8JECT3?D .. _ HBLD I? ,T ,N0 L'N V13STI 0 A T I ON
:�i'PKUYGI3 ur RtilC{C1'E17 Myri haq4 two (21 riviiot,tucro:
s
l i) 1'tl't! �l;Yt.'I(a1N1't't
Mgll ti•Ai�piicaiioa,uy LA Qi1fN- A POLO t3STATB' ASSOE,EATION
• afo Fvrtuaa Vlvrt MonaQ,auent
73-060111 l'ealoo. Suite 3 (treat)
Palm Atvort. CA 92240
corTAUM 0 1992 Patuat \V•u Wmapwolu