04612 (PAT)TAtyl 4
ay, ^':
•T ..." • P.O. BOX 1504 ,
Building78-105 CALLE ESTADO
Address 54- 845 Obre4on ,I � LA QUINTA, CALIFORNIA 92253.
Owner
Lott. L. 'Filmer - BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address 222 Madeline Drive _. 774-293-011
Number..
City Zip Tel. ' + ' r ~ J A.P.
140rIIvrovia 9141 -1181358-3795- Legal Description Patio and Cover
Contractor Project Description
Omer/Builder
Address
City Zip Tel.
State Lic. City
'& Classif. Lic. # Sq. Ft. 240 No. No. DW.
Arch., Engr., Size Stories Units
' Designer New ❑ Add d Alter ❑ Repair ❑ Demolition ❑ '
Address k; Tel.
City Zip ` State'
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 OO) of Division 3 of the Business and Professions Code, and my license is in full force and
effect:
SIGNATURE DATE•
OWNER -BUILDER DECLARATION Estimated Valuation ee!!�+� ��y rr��
I hereby affirm that I am exempt from the Contractor's License Law for the following y12920
- -
,_ reason: (Sec. 7031.5,Buslness 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 • PERMIT AMOUNT
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 Plan Chk. Dep. ,
• subjects the applicant to a civil penally of not more than five hundred dollars (8500). y
❑ I, as owner of the property, or my employees with wages as their sole compensation, will . Plan Chk. Bal.''.' ►i 4
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. F7 ii
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, Mech. -
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 " Electrical '
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- Plumbing
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 S.M.I. -J�i-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading -
O I am exempt under Sec. ' 113. & P.C. for this reason
Driveway Enc.
Data. r' -i Owner -r+ ✓ -� -" ""` Infrastructure.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of 3
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.
TOTAL
t>4 o W.1 -
CERTIFICATE OF EXEMPTION FROM •
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be , completed if the permit is /or one hundred dollars ($100) valuation
L'
or less.)-
of
I certify that in the performance the work for which this permit is issued, I shall .not
-
employ any person in any manner'so as to become sdbject to the Workers' Compensation
Laws„of"California'] +. %%
Dateii.Ownera :-' OC,-%�•. ^s..� _.
NOTIEE TO APPLICANT: 1%"alter making thi Cert!/icate o/ Exemption you should become
ZONE:
BY: - -
' comply it the Workers' Compensation provisions d the Lebor Code, you must rorthwilh
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:
,
Front Setback from Center Lirie
r;
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
_ work for which this permit is issued. (Sec. -3097, Clvil Code.)
Side Setback from Property Line -
Lender's Name
'
Lender's Address -
FINAL DATE
INSPECTOR
- 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.
1,
I certify that I have read this application and state that the above information is correct.
ISSUed by:
Date Permit
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. :
Validated by:
Signature of applicant 'Date-
Date
Mailing
Mailing Address
Validation:
City, State, Zip _
f.
.. ' -. a .,.
�
ii �
•ASSESSOR'S
t• „ r
WHITE FINANCE PINK APPLICANT GREEN BUILDING, GOLDENROD OFFICE HARD COPYFILE r
rte, .. '-� _t•" ?ta _.. •: y:; !''•.. .�"`i.r, ..-k .. •.�,.�'*�' �... -,kL.. -. :� ei. -„... _....r,, ;,-. .:a��:� : ��l...-+'�.-< ..-..-.._n-+�. .�•....-tit. •.tA {....�• .. .. ,_.f ... ,.. :�t'-` _-"
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
iS7 FL SO Fl tp $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. a
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FT. eft
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GARSO. FT. 0
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT.a
FINAL INSP.
WALL SO. FT. @
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ _plus_x$
=S
URINAL
SO FT 0
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION $
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(AUTONDISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRYTRAY
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
SO. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID iIA c
SEWAGE DISPOSAL
SO.FT.GAR r8 3/� c
MOUSE SEWER
FINAL INSPECTION
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 8 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
//��^�
kLFOUND. REINF/ '/ — �6
!'' ° /
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ _plus_x$
=S
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 SIGNATURESIINITIALS
GARDEN WALL FINAL 7d