10292 (PAT)P.O. BOX 1504 N o . 1,0292
BuildinAddress 44-830 Seeley Drive LA QUINTACCALIFORNIA 92253
Owner
Anthony Mardes Ch .
Mailing BUILDING: TYPE CONST,' OCC: GRP.
Address sane
A.P. Number
City Zip Tel,
,Qus.t 9253 Legal Description
Contractor
QWner/RE:xlC e --r Project Description Patio -Co .yar
Address.
City' Zip Tel.:
State Lic. City
& Classif. Lic. # Sq. Ft' 560 No. No. Dw.
Size Stories, Units
Arch., Engr.,-
Designer ' New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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 r l
OWNER -BUILDER DECLARATION Estimated Valuation �g
I hereby affirm that I am exempt from the Contractor's License Law for the following !.y 336..00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county whichrequires a
permit to construct, after, improve, demolish, or repair any structure,, prior to its issuance also ° AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to _ PERMIT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/ r
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 penalty o/ not more than five hundred dollars ($500). _ - t,} v + 5
_
.%p* as owner of the property, or my employees with wages as their sole compensation, will" Plan Chk. Bal. _
Ido the work, and the structure is not intended or offered for sale. -(Sec. 7044, Buishess and Const. V y • U
Professions Code: The Contractor's License Law does not apply to an owner o/ 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.)
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
•-strucl the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law �.
does not apply to an owner o/ property who builds or improves thereon, and who contracts for S•M.I.-
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
i Grading
O 1 am exempt under Sec. -B:-&- P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of f.
Worker's Compensation Insurance; or a certified copythereof: (Sec. 3800; Labor Code:)
Policy No. Company ' tr¢ 3 �) t @
❑ Copy is filed with the city. • ❑ Certified copy is hereby furnished. + ��'"I'S'��'rz°r -r '�AA4 %.1 3 }k":1. Q Q A � ►. Z'
TOTAL
CERTIF.ICATEOF�EXEMPT IONFROM' "'' REMARKS '
WORKERS' COMPENSATION` INSURCddollar-s
s
(This section need not be completed 1/ to permit is /or one $100) valuationor less.)I certify that in the performanceo�q,work for which)tued, I shall not
employ any Person i�iany m` oei so as ao. become subjectCompensation
Laws of California Datenerp ,
NOTICE TO APPLICANT. It -after making thiV CertIA6&e'of Exemption you should become .ZONE: BY:
subject to the Workers' Compensation provisiond o/ the Labor Code, you must forthwith 'MInlmUrrl Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line ,
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.) 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.
I certlfy 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 c .
construction, and hereby authorize representatives •of' this city to enter the above•.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip 4
a
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
" IST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CARP. SO. FT.
WALL SO. FT.
SO 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SO. FT. a c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING / / �//
vl 6(
FINAL INSP.
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
V
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE �
FOUND. REINF.kv
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 / / �//
vl 6(
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
:d