PAT (9809-141)44640 Marguerite Ct
9809-141
LICENSED CONTRACTOR DECLARATION
thereby 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:
( r)" 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,)./`
() vam exempt under Section B&P.C. for this reason
,pate q e'? 111 CSignature of Owner// )
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofdfhe 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).
(o,l 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
subje t to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with thAe provisions.
Date: ?✓ ! 1 r Applicant h rt
t
Warning: Failure to secure Workej rs
A CO pensatjon cov-yame er ge islawful and
shall subject an employer to 9' i riinal peri Ities and civil fines up to $100,000, in
addition to the cost of compensation, mages 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.
I certify that I have read this application and state that the above information iso`
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby auth ze representatives of this City to enter upon
the°above-mentioned property for nspection purpos s.
VSIgnature (Owner/Agent) Z Dae Q b cf k% "
BUILDING PERMIT PERMIT4)8(19-141 CONTROL#
DATE 9124/!)S VALUATION $2,779.70 LOT TRACT 8260
JOB SITE
ADDRESS 44-640 i IAR'f UERI F, OUR.
APN 064-2514,032
OWNER n
CONTRACTOR/DESIGNER/ENGINEER
JAY A. & Gf,OMA D f0i' %i R.
OWNER 131JILDU
44640 MA:RGUi;: UTE Cr
LA QI?1,NTA. CA. 92253
i - CRU
USE OF PERMIT
PA10
209 S.F. OPEN LA TICS PATIO COVER
rOR€:[PATIO Sr
: wI1= AIA.T1M COST OF COI' MUCiIONr
dd pp ^ q , ,y? y ;. --++ r ,£p,
:RAA l1lY.6 T RI lti 1VLYJf NILUtL
PLANCHECK K FE :!01. -NO -439-3:18 515.10
f't 3 i`; I) ;'r►c)t ) x?9 101-tM-413i-fXII)
MU0j,40 MOT1►. N 17 037 - R.EZ3,3113 1011 -000-14 t MO 5.50
Z
ftAf. C',; RUC TION AMI) PLAN CHECK
SEP ON
11%0
LESS, r1Rr,._f 1,A4' 3 FEES
00
~ j ` ' c? ' j 1 ' i ii't. ` 'i18:. '.[+',I 41T .+ KP!+ ,`5.0UE i`Jff.)W
OF UU t
$89.4;0
mil e
off (
S 1
( •4 1
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
t
Final
Utility Notice (Perm)
COMMENTS:
'P.O. BOX 1504 No., 08 S S
Building 78-105 CALLE ESTADO
Address 44.640)$erne CoUrt LA QUINTA, CALIFORNIA 92253
Owner
A c ic At BUILDING:. TYPE CONST. OCC: GRP.
Mailing
Address - A.P. Number Trlar_t 21 202 Panne
' n
City Ip ---"' Tel.
VAlyn, Legal Description ('sxr!^rta VIrmbw
Contractor Project Description ►j, „a A _ 1.0t 52
r± s
'Address :t..
City Zip Tela r
State Lic. City
& Classif. T , ..493919 Lic. # 12USq. Ft. 21M No. No. DW. ..
Arch'., Engr., Size 'Stories Units ,
Designer New ❑ Add.❑ Alter ❑ Repair ❑ Demolition O'
Address \ Tel.
City Zip, State r
Lic. #
a LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions.of Chapter 9 (commencing with Section t
70 00) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE- - DATE
OWNER-BUILDERDECLARATION
I hereby -affirm that I am exempt from the Contractor's License Law for'the following .: Estimated Valuation ' I1 ,
reason: (Sec.. 7031.5, Business and Professions Code: Any city or county which requires a 5 VJ •,rt
,permit 'to, construct, . alter, improve, demolish, or repair any structure, prior to its issuance also ,
`requires the applicant, foi. such permit to file a signed statement that he is licensed pursuant to _ PERMIT AMOUNT,' .
the provisfons.ol 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 live hundred dollars ($500). :1
%O I, as owner of the property, or my employees with wages as their sole compePlan Chk. Bal.
nsation, will
the work, and the structure is not intended or offered -for sale. (Sec. 7044, Buisness and a
/essions Code: The :Contractor's License, Law does not _apply to an owner. of property who COf1St. li ga5{
' `
r builds or improves 'thereon and who does such work himself :or through his own employees, McCh- r 'd,
'. piovidad that such improvements are not intended or. offered /or sale. If, however, the building . -
':
'of lmprovement.is sold within one year of completion, the owner -builder will have the burden
,
= o/proving that he. did not build or improve for the purpose of sale.) ElectFical
- '
120.1.7
❑ 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 _
;4- does not apply to ah 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.) - •
`Grading F:
.0 1 am exempt under Sec.' ' B. & P.C. for this reason
Driveway Enc.
Date::!:; pwner . Infrastructure ;
> WORKERS' COMPENSATION DECLARATION 1 j
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. O Certified copy is hereby furnished.. ` • - s^'
TOTAL y -
CERTIFICATE OF EXEMPTION FROM REMARKS r • %
WORKERS' COMPENSATION INSURANCE
(This section'need notbe completed' if the permit is /or one hundred dollars ($100) valuationor less.) i
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, after making this Certificate . of Exemption you should become =B
ceEs " •` • Y l .c 1
subject to the Workers' Compensation provisions of the Labor Code,. you must lorthwilh Minimum Setback Distan`''>5: tC7 J,""'4` ,:'s'aaJ.#'
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
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 _
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: Data 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:
Gty, State, Zip
r 'C'- • •. o. _ _ x.. rr. .>_ ,.rr. ' -t, y t S r y °, k .f y, r r Y, t 24
.ras^ k :yf- . ' ... . t _ 'A ra e> i }. - ` .S .. ;l l ss x ,. '-, •• t' t-`'•.! % .+, a s..`C .Y a tL•.•+ njs ., _ bla i,r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SQ, FT, ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) $— / ! L
!
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
/p
FINAL INSP. lZ `�
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SQ.FT.GAR p 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
01
GROUND PLUMBINGI,-2,1
NDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE L
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. fi
GAS (ROUGH) $— / ! L
!
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plu3 x$
_$
LUMBER GR.
/p
FINAL INSP. lZ `�
FRAMING q(AV0vcp
FINAL INSP. ( 2/�
ROOFING G/ I11 41 lb
(,�1r�►j C lO �C
y�
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING �Q
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION / �3 f
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL