07968 (SFD)4 4 QUA
P.O. BOX 1504 a.K
Building 7&105 CALLS ESTADO
Address 55-355 Pebble Beat LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
City Zip Tel.
Contractor I
. Gustafson/Whipple Inc.
Address
& Classif. $98379 I Lic. #
Arch., Engr.;
Designer .. .
Address Tel.
City( Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirmAhat I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Diiviisi}on-3 of thesBusiness and Professions Code; and my license is in full force and
effect:_` /Ff l Irl rM. d l , : fi 1�� .
SIGNATURE . y. _r - - e R_,., DATE
OWNER -BUILDER DECLARATION i
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 file a signed statement that he is licensed pursuant to
the provisions or 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).
O 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 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.)
❑ 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.)
❑ I 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
O 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 thV 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 or Exemption you should 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.
4
CONSTRUCTION LENDING AGENCY
f 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.)
Len6r's Name
Lender's Address
4his is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
(;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
cobstruction, 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
No. 07968
BUILDING: TYPE CONST. OCC: GRP.;
A.P. Number 760. ClLflAA
a�no� a
Legal Description lot Al
Project Description��•.w1=�.1� w..
Sq. Ft.
Size
New ❑
No.
No. Dw.
t1nits
Add ❑ Alter ❑ Repair ❑ Demolition ❑
imated Valuation.
PERMIT,
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
1 Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
ZONE: BY:
Minimum Setback Distances:
Front Setback frorr Center Line
Rear Setback from (Rear Prop. Line
Side Street Setback from Center Line
Side Setback from 3roperty Line.
FINAL DATE INSPECTOR
Issued by: Date 5121/90 Permit
Validated
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
2ND FL. SQ. FT. @
POR. SQ. FT. @
GAR. SQ, FT. @
CAR P. SO. FT. @
WALL SQ. FT. @
SQ, 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
FINAL INSP.
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES��FEE
FIREPLACE
MEC!FEEdPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBI;3` `T
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 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 SIGNATURESJINITIALS
GARDEN WALL FINAL
, e
JAMES D. FEIRO
Civil Engineer - Land Surveyor
P.O. Box 12980
Palm Desert, California 92255
(619) 346-8015
Fax (619) 346-2548
July 2.0; 1990. u...
City of La Quinta
78105 Calle Estado :v
La Quinta, CA. 92253
ATTN: Engineerin
4 R 55-355. Pebble Beach
'dw
This letter will serve to state that we::have field checked
the finished floor elevations of' the- above project and...,found; t-hem`
to be 494.53 (high-) and 494.46 (low). Plan elevation is 494.50.
Sincerely,
D. FF `�. J a e s D. Fe i ro ,
C -LS
Lo No.. C-24176
`E'
4P CIVIL@
�..
o" � �d��o EXPIRES 12131193
'1hU/ UbUUS
12/30/86
COACHELLA VALLEY UNIFIED SCHOOL DISTRICT
CERTIFICATE OF COMPLIANCE
(Government Code §53080)
Project Name:
Project Address: 55-355 Pebble Beach, La Quinta PC
Project Owners Name: Kay & Donald Bennett Phone No.:
Project Description: Dwel.linq
Building Type (circle one) Residential (Include.No. Dwelling Onits)
XX Commercial Industrial
Tract No. Lot' No.
(If Tract attach Schedule "A" of all lots by tract, square footage for
each lot and total.)
Assessor's Parcel No.
(If Schedule "A" is used show Assessor's Parcel No. for each lot if one
exists or Assessor's Parcel No. for parcels before sub -divided.)
Total square feet of Building Area: 5,600•Sq. Ft.
Certification of Applicant/Owner. The person signing certifies that
the above information is correct and makes this statement under penalty
of perjury and further represents that he/she is authorized to sign on
behalf of the owner/developer.
Dated: Signature:
City/County Certification:
(signature)-.. OPTIONAL
(title)
(to be completed by school district)
School district requirements for the above project have been or will be
s�,i.s--.i in accordance with one of the following (circle one) :
Gov. Code Gov. Code Agreement existing
53080 65970 prior to 1/1/87
(XffiX�&�16) ( SB 201 )
AB 181
Total n r of sq. ft. 5,600
Amount sq. ft.. $ 1.56,.
collected 8,736.00-'
School District Offic
Jorge B. Gutierrez Phone No. 9 = 3 9 -
Note: AB 2926 and
residential
foot for .ca
,.
Not subject to
fee,requirements
L
Aasistant Superintendent
tle Fanilities & Operations
,TiDa urJ -e -,-1990
1 fee are capped at $1.56 per square foot for
ruc on. AB 2926 is capped at $0.2$.per square
and industrial projects.
' ' R
GUSTAFSON DESIGNER
WHIPPLE, INC. BUILDER
Lj Lf 74-900 Highway 111, Suite 123, Indian Wells, CA 92210. (6.19) 568-0968
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