PAT (9606-050) + SFD (14033)78760 Lowe Dr
9606-050
14033
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). „ r
-O I am exempt under Section B&P.C!for this feason /
Date r tcl / </l, Signature of Own2r lh. . -ft V.% 1 `,
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
()/1'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 to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of sectio 3700 of the Labor
Code, I sh II f1hwith comply with those pro`visi p
Date: / % / <74 Applicantt j
Li'
Warning 'Failure to secure Workers' Compensation overage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $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.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
l,certify that I have read this application and state that the above information is
correct. !agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for'. inspection,purpo7LOate
,.Signature (Owner/Agent] &
BUILDING PERMIT PERMIT# CONTROL#
X61)&0. 3486
DATE 6112/96 VALUATION '55.2414►.30 LOT 1.Q TRACT A
JOB SITE •
ADDRESS 78-760 L{j` lE Aid.
APN
OWNER
CONTRACTOR / DESI)G N /}ENGINEER
/ } A p rye*) ) (
t 1[,10E 0. AY i • URRE
t (E)R
0W.".i: lJ BIJI DISI .
714-7140 LOWE Rpt
LA QUi! I A CA 92253
304077
C13J it
USE OF PERMIT
NA"1'It }
19t.`.iF LAITIC17 PA110 MVEA
1't.Jkk;NPAf0 3'}i.W 4t~
UST1fL1A x;11 COST OF i.t NI Sl.ttU 110IN
5,2011.30
PE1tA'il'1"FiP;i':S[IMNIAR
PLAN 1:N4:CK r tW 101.01)11-4 9-318 $52-0
`0N'+I'RUr"f(10 tt•rJ [Q -fit$:1'Lkt i $$tfl0
P`rly1`1-T p1 i7
?'1titYlt1 51.)A":t,ii l 'i S-i C.. ll7% f 140-2'E1-i100
4f.I13-'r0TAL CON CR1Ir_110N AND PLAN CHECK,
$13417
LESS PRC -PAID FES
1000
( Y O A4 Pi'.RN41 fi FE Off t+. NOW
S 1.14.17
JUN 1 _ 10 ,
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade X
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath or
Drywall - Int. Lath
Final
Final
BLOCKWALL P _ ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location _
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL. APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
RAFTER SIZE AND SPACING
SPECIFY ROOFING AND SHEATHING OR OPEN LATTICE
(SEE ROOFING NOTE ON REVERSE)
--------------------
R0 PITCH
. • • • •
r/P --
;
CONTINUOUS LEDGER
IM
HEAW
4
T AND 'L' STRAPS
II (WITI
-/�
(4) 16d NILS OR BOLT
L
RAFTER SPAN:
POST SPACN'
O.H.
O.H.
r
3
/ /
OVERALL LENGTH:
OVERALL LENGTH. /
Hyl
„ >n
MIN. r'xr P06'iS
REAR SETBACK
SIDE SEIVACK
2000 P.S.I CONCRETE -- FINISH GRADE
FINISH GRADE 6- MIN. /1
I
� ��G
PROVIDE 1' CLEARANCE
BETWEEN POST AND
�lGli
CONCRETE
OPEN LATTICE PATI) COVERS MAY BE ATTACHED TO EXISTING FASCIA
VIA ONE 1/4' x S LAG SCREW THROUGH FASCIA INTO EACH RAFTER TAIL
U -STRAP OR ANGLE
NON -CORROSIVE PLATE „epi
3/8' x S LAG SCREWS INTO STUDS AT 1Ir
O.C.
CONTINUOUS LEDGER
_
(4)- 1 eC NAILS
OfE BOLT
v !
U -STRAP OR ANGLE
(1)- Idd NAILS
Q�
BOLT
JOIST HANGER OR SOLID BLOCKING
NAIL RAFTER TO BLOCKING -
ANCHOR BOLT (EMBEDPROVIDE 1' CLEARANCE
T MMI. INTO CONCRETE) BETWEEN POST AND
CONCRETE
BUILDING DEPARTMENT USE, ONLY
TYPICAL PATIO COVER
PERMIT NUMBER ; , .
DATE OF APPLICATION
PERMIT ISSUE DATE
OWNER'S NAME
�-
FINAL INSPECTION DATE
ADDRESS
crtY,'ST ZIP
r
E i `�.l A' FLV! LE CUL�c
aAL ooNOTnoNs e , ,
TELEPjNONE
-4 772
r v
BATE _ -- -- -:
H.OA APPROVAL SIGNATURE. DATE
• U
P.O. BOX 1504 No. 14033
Building ' 78-105 CALLE ESTADO
Address 78-760 Lowe Drive LA QUINTA, CALIFORNIA 92253
Owner •
Acacia -Construction
Mailing BUILDING: TYPE CONST. VN OCC: GRP. R3
Address 8141 b'. Raiser Blvd. #310 A.P. Number 604-232-039
City Zip Tel. Lot 168 Tract 23268-3
-Anaheim, CA 92808 , (714) 282-5800 Legal Description
Contractor Project Description SFd Plan E
Same
Address Acacia Homes"
-
City Zip Tela
State Lic.,,,1 293954 City 1612
& Classif. Lic. # Sq. Ft. 2358 No. No. Dw.
Arch.,-Engr.- - Size Stories Units
Designer DC Design New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
A s351 3svine Ave. Tel.,1411641-1505
City Zip St to
Santa Ana Haights, CA 9: 06 *0
LICENSED CONTRACTOR'S DECLARATION
�I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
ti00) of Of 3 of the Business and Professions Code, and my license is in full force and
effect. is )_ 2-ct -
qq
SLGNA7URE - DATE
OWNER -BUILDER DECLARATION Estimated Valuation $1411,073.001
I hereby affirm that 1 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, 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 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 Plan Chk. Bal. 658.06
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 786.50
Professions Code: The Contractor's License Law does not apply to an owner of property who . - C
builds or improves thereon and who does such work himself or through his own employees, Mech. JC•.rjS}
provided that such improvements are not intended or offered for sale. If, however, the building 5 0
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 159.33of 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 168.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law 14.11
does not apply to an owner of 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 am exempt under Sec. Grading 20.04 B. & P.C. for this reason '
Driveway Enc. .00
Date -Owner Infrastructure 3,174.15
Arta n c Places CT2.
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.)
Policsy o.-- .Company
O'.Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL �, rr •
CERTIFICATE OF EXEMPTION FROM REMARKS
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: If, alter making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
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, Civil Code.) ,•- Side Setback from Property Line
Lender's Name r
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 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
Mailing Address Validation: /
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
T
COLL. AREA
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
ROUGH PLUMB. O
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
ROCK STORAGE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (ROUGH) /Q
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL) 6
v
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.
SQ. FT. ® c
BATH TUB
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 ELECTRICALJ HEATING & AIR COND. SOLAR
A
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 4
ROUGH PLUMB. O
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER.
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) /Q
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) 6
v
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
RADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.'
FRAMING/
FINAL INSP.
ROOFING
VENTILATION
//) •C•l/v•
`/ 7
r
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIRE/WALL
LARING
MESH
INSULATION/SOUND �!
FINISH GRADING
FINAL INSPECTION O
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL