12207 (PAT)P.O. BOX 1504 N 0 . 2220T \
Building
'78-105 CALLE ESTADO
Address 44 -930 -Seeley .Drive LA QUINTA, CALIFORNIA 92253
Owner
Mr. & Xrf .. David Bryant BUILDING: TYPE CONST. OCC: GRP. -
Mailing
Address Same
A.P. Number
City;�„ Zip
' Legal Description -
Contractor •' -Patio Cover "
-B.Q.S..5. ,•Conntruct i.o2i Project Description
Address = '
38-•621 `Patrick Drive
cityIndio, CA ^ ' Zip•92243 Tel345-'9228
State Lia ( City.
& Classif. $ 5011638 ,t •LA # �0:2 � } 'Sq. Ft. No. No.-Dw.
` Size 280 Stories Units _ 1;
Arch., Engr.;- ;
Designerr, s�: �`""""^"' New ❑ Add ❑ Alter ❑ Repair ❑ Demolitioni ❑
` Address Tel.
City Zip • State �.
. Lic. #
rt
LICENSED CONTRACTOR'S DECLARATION "•
I hereby affirm that 1 am licensed underf rovisions of Chapter 9 (commencing with Section —
/7000) of Division 3 of the Business an r0rofessions code, and my license is in full force and
JeffecL / /yJ*e • �/�
FSIGNATUR '^ 'r - .r'` . DATE
OWNE
,RfErUILDER DECLARATION i
Estimated Valuation $
I hereby affirm that I am exempt from the Contractor's License Law for the following !f 584 00
r
reason: (Sec. 7031.5,Business and Professions Code: Any city orjcounfy which requires a
permit to construct, alter, improve,. demolish, or repair any structure, I prior to its issuance also - AMOUNT
requires the applicant /or,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) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis r
/or 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 (S500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bala.' - - 40 o 9`5
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COf1St.. o ��
•Professions Code: The Contractor's License Law does not apply to an owner o/ property who
•;�buflds or improves thereon and who does such work himself or through his own employees, Mech.
!provided that such improvements are not intended or offered /or sale. If, however, the.building• _ -
••'`:or'improvement is sold within one year of completion, the owner -builder will have the burden
el - of
'
Electrical
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- 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. .28
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 Grading
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 ^
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company, _
opy is filed with the city., ❑ Certified copy is hereby furnished. - ! ^ ••
JJJJJJ TOTAL 0 4 .-Z:5
• •CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE _ ^g
.�
(This section need not be completed If the permit is /or one hundred dollars ($100) valuation
or less.) 1• Q
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject io the Workers' Compensation
Laws of California.
Date Owner -
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. MLJU A,
Front Setback from Center e
Rear Setback from Rear Pr ,pDlLjne
CONSTRUCTION LENDING AGENCY Side Street Setback from Center ijKJ
-
I hereby affirm that there is a construction lending agency for the performance of the f{
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line fF
Lender's Name - - .. V '
Lender's Address FINAL DATE—INSPECTOR «�
This is a building permit when properly filled out, -signed and validated, and is subject tow
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.. Issued by: Date Permit
1 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
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SQ. FT.
GROUT
WATER HEATER
WALL SQ. FT. ®
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
_$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FIRE ZONE ROOFING
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
LATHING
SO. 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
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./EQUIP.
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 SIGNATURESIINITIALS
GARDEN WALL FINAL