15367 (BLCK)Building
Address 53-120 Juarez
Owner_
Michael Dietrich
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
mailing
Address 51-960 Herrera
City Zip Tel.
La Quint -e 92253 771-1561
Contractor
'Double 4 Construction
Address
same fibve
Zip I Tel.:
State Lic. City
& Classif. &81012 I Lic. # 323
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
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.'
SIGNATURE DATE
1b 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 rile 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 rive 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.) .
❑ 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) (sensed pursuant to the Contractor's License Law. j `
❑ 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, ❑ 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 thg 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: ti, after 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 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
No. 15367
LDING: TYPE CONST. -OCC: GRP.
A.P. Number
Legal Description
Project Description- 1001 @ 6' Garden Wall
504 Q 5' Garden Wall
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $3,583.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. ' "r •
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
'ZONE:, ' BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Re DP Line
Side Street Setback CenTe Line
Side Setback from rty 'nil
FINAL DATEr PECTb�� f r
Issued by:_
Validated t
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINii FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
GAS (ROUGH).
DRAINAGE PIPING
WALL SQ. FT.
OTHER APP.IEQUIP.
DRINKING FOUNTAIN.
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM • FAN' EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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, TEMIPERM
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+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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.IEQUIP.
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. OCG
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS
GARDEN WALL FINAL
V,'$:cb CRISTE, PIPPIN & GOLDS
Montezuma Oeste
Inc-.
73-550 Alessandro Dr., Ste. 200
Palm Desert, CA 92260
f
May 28, 1996
City of La Quinta .
Building Department
As of today's date, Montezuma Oeste, Inc. is replacing the current contractor, Mike Dietrick of
Double D Construction, on our construction projects at 77-290 Calle Chihuahua and 53;120
Avenida Juarez. Montezuma Oeste, Inc. will now formally assume the role of owner -builder on
e two properties. You are authorized and requested to list Montezuma Oeste, Inc., on the
necessary permits and documents related to both construction projects.
In addition, please issue directly to our new construction supervisor, Dennis Melilli of D. Melilli
Construction (Lic. 275452), the current Building Cards, noted with all inspections to date, for
both ;properties.
Finally., if possible, please release directly to Dennis Melilli an extra set of stamped plans for
each property.
Thank you for your cooperation and assistance in this matter.
Sincerely,
Fred Wilson '
Vice President
Montezuma Oeste, Inc.
cc: Irwin Golds
Dennis Melilli
Iris Wilson