15789 (MISC)4 1? - ,
P.O. BOX 1504 N o . I V81
Building Tao Quirt€ Resort's Club 78 495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA.92253
Owner RSL
Mailing BUILDING: TYPE CONST. VN OCC. GRP.-
Address 56 -140 PGA Blvd
A.P. Number
City Zip Tel.
La i u1.t' to 92253 Legal Description
Contractor Richard Dodson Project Description. Reservation Consolidation
elation
Address
City/ Zip Tel.
l340-7955
State Lic. City g✓;
& Classif. � �, Lic. # 21 Sq. Ft. 672 No. Z No. Dw.
Units
Ar h C. E314 7! Size Stories X
Designer eta Craig Pearson
Address 41--365 Boardwalk f 1, 0 346 -0196
City Zip State
Palm Desert 92211 Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby, affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
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 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).
❑ 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.)
❑ 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
❑ Copy is filed with the city. O 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 the work for which this,permit is issued, I shall not
remploy any pperson in any manner so as to become subjecVto the Workers' Compensation
Laws
ofsCaliforhfa" i'
Date `/.E// � Owner -ds if' c..tir,d' elf �• ...., ...
NOTICE TO 'APPLICANT: If, alter making this Certificate of 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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 1 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
New ❑ Addl® Alter ❑ Repair ❑ Demolition ❑
Aimated Valuation $39, `45..00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
80.44
Plumbing
+ 27.00
S.M.I.
8. rob
Grading
U. uo
Driveway Enc.
Infrastructure
TOTAL
°� •
REMARKS
ZONE:
BY:
Minimum Setback Distances -
Front Setback from C u e
Rear Setback fro Ptop ne
Side Street Set ck from ine
Side Setbac�rom Prey y Li
FINAL DATE
INSPE``CT
Issued by:
Date it
iYs
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBINU FEES
1ST FL. SO. FT. ®
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT. ®
WALL SO. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
c
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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
SO: FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 1/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT. FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
H.FEE
MEC.FEE.
PL.CK
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. REIN (//_
l
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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. FIREW ALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
,
GARDEN WALL FINAL
Contra
Owndr
This form shall be posted on the job with the Building Inspection Card at all times is
conspicuous place. It is the responsibility of the General Contractor or the Owner/Buil
to monitor the sub -contractors that are on this list are the same persons performing
work. Any changes of this list must be approved by the City of La Quinta Department
Building and Safety prito work being performed by a changed sub -contractor. Failure
comply will resor ult in a stoppage of work and/or the voidance of building permit.
TRADE
SUB -CONTRACTOR NAME
CONTRACTOR'S
LICENSE NO.
WORKMAN COMP.
NO. ON FILE
CITY BUSINESS
LICENSE NO.
GRADE/
EXCAVATE
PIPELINES
CEMENT/
FOUNDATIONS
CEMENT/WALKS
&- DRIVES
ASPHALT
FRAMING
eSS S
I614
STEEL/
STRUCTURAL
--
MASONRY
DI
PLUMBING
//
b.
LATHING
DRYWALL
PLASTERING
HVAC
zJ
ELECTRICAL
ROOFING
SHEET METAL
FLOORS
GLASS/
GLAZING
P
']
l
INSULATION
SEWAGE DISP
PAINTING/
DECORATING
n23 CO/� '1
`> �J /J
TILE
J
INSTALLATION
SQ
C6 L a
ORNAMENTAL
METAL
FENCES/
BLOCK WALLS
LANDSCAPING
k,,4
OTHERS
N