PAT (0401-019)44340 Marigold Lane
0401-019
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). e
( ) I am exempt,under C`-
nder Section B&P.for;,th sI reason
Date 4! Signature of Owner^ -
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).
( ) 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 to the .
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisionsjof 'Sbction 3700 of the Labor
Code, I shall forthwith comply with those provislonsl
Date: 1— t+--{ Applicant 'j Q - -
Warning: Failure to secure Workers' Compensation coverage 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. e
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 is,
correct. I 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 purposes.
Signature (Owner/Agent) ``-ti---'""Date
BUILDING PERMIT PERMIT#
— 0401-f31.9
DATE S ;VALUATION4W3.20 'LOT TRACT
JOB ADDRESS 44,1•+0 RIC -1.0, T) LANE ---
APN
OWNER -
r.
CONTRACTOR / DESIGNER / EN INEER
44.340 z, ARIGOIJ) LA1TE
LA QTM,, fA CA 9 253
(> - aBLO
USE OF PERMIT
PATIO
304 SFLATTICE ATTICE P)Vf10 COVER FFP CITY a" T91NDAMRLTAR YARD.2001
c8c.
rC?ROVIIAT IO 304,00 3F
N3'd,UM7711) COST 07F (.'(JNSIMUCMKINN
4,04320
PLAN CrHWIX FFI 101.000-4.39.318 T146.80
CONSTRUCTION F.EM 101-000-418-000 Mt .00
fi:'t1i.ONO MOTION TIRE - RESID 101-000441-000 190
,9178 TOTAL C01MRDC•Tr,01sT.ArND PLAN t:'3;11M9
$119.20
LESS PRE -PAID RE
$0,00
JAN 0 6 2004 j"
CIT`ti OF LA QUlNTA
R A7 !!
BY ti" DA INA
SPECTOR
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 APPR VA
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 tines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ShowCc 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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Twit
P.O. BOX 1504 N o .
Building D 78-105 CALLE ESTADO
Address 44-30i i r gold Latae LA QUINTA, CALIFORNIA 92253
Owner
La Ouitata. Annociataa
05893
Mailing BUILDING: TYPE CONST. : OCC: GRP.
;,Address 43-Z75 Washington St.
A.P. Number
City Zip Tel. Phase 11 Lot 4
' P.D.J32263 1Legal Description
Contractor E.G.
;r /ssgq illiams pT! fee . Project Description P1aa 2A Cactus Plower
State Lic.
& Classif. 3313
Alter ❑ Repair ❑ Demolition ❑
I City
Arch., Engr.,
Minimum Setback Distances:
Designer
Address
Tel.
Lic. #1231 .. I Sq. Ft. 1621
. Size
I Lic. #
EN
f LICSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
1e7000) of Division 3 of the Business and Professions Code, and my license is in full force and
r
,_ }SIGNATURE DATE
r OWNER -BUILDER DECLARATION
.1 hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Busness and Professions Gide: Any city or county which requires a
Per"* to construct, after, Improve. demolish. or repair any structure. prior to its issuance also
requires the applicant for such permit to We a signed statement that he is licensed pursuant to
the provskons of•the Contractor's License law, Chapter 9 (commencing with Section 7000) of
Mvsion 3 of the Lirsimess alb Professions Code, Of that. he is exempt therefrom, and the basis
for the alleged exemption. Any viabliian of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a c" penalty of not more than five hundred dollars (5500).
❑ 1, 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, Buisness and
ry
Professions Code: The Contractors License' Ladoes not appy to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such Improvements are not intended or offered for safe. If, .however, the balding
or improvement is sold wffhim one year of completion. the owner -budder will have the burden
of proving that he did not build or inprove for the purpose of safe.)
,❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractors License Law
does not appy to an owner of pmperty who builds or Improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractors License Law.) .
❑ 1 am exempt under Sec_ R. 8 P.C. for this reason
Date owner
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
.17`Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars (5100) valuation
or less.)
1 certify that in the performance of lhg 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 California.-
No. No. Dw.
Stories Units
New Add ❑
Alter ❑ Repair ❑ Demolition ❑
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions kaorthspermitslaobedeemmedrevoked.
Minimum Setback Distances:
Front Setback from Center Line
t
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Estimated Valuation
87,5149,00
PERMIT
AMOUNT
Plan Chk. Dep.
work for which this U
permit is issued. (sec. 3097, C Code.)
Plan Chk. Bal.
488.77
Const.
585.50
Mech.
53.50
Electrical
104.00
Plumbing
123.00
S.M.I.
6.16
Grading
Issued by:
Driveway Enc.
I agree to comply with all city and county ordinances and state laws relating to building
Infrastructure
1969,07
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
TOTAL
3330.00
HtMAHKS ""I", fi C)':T s li `§ mi'i FRa ••'l - ? .- . i M
i:tiJ $t ;t IEi i tDf_ 1 ,.i 3 •,:LV a' :'ii
ner
NOTICE TO APPLICANT: lf, after 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 kaorthspermitslaobedeemmedrevoked.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
1 hereby affirm that there is a construction lending agency for the performance of the
work for which this U
permit is issued. (sec. 3097, C Code.)
Side Setback from Property Line
Lender's Name
Lenders 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.
6-15-895-89
1 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. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE 7
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SQ FT ®
DUCT WORK
ROCKSTORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
r ER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SQ. FT.
gPO
GAS (FINAL) (
WALL SQ. FT.
DRINKING FOUNTAIN.
GROUT
URINAL
FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ -Plus-x$-=$
FLOOR DRAIN
MECHANICAL FEES
,r1
FRAMING �� Z
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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 GOND. SOLAR
SETBACK
GROUND PLU BING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 7
OUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH) e( I1
r ER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL f/ 3
gPO
GAS (FINAL) (
POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP. Z Z�'
GRADING
cu. yd.
$ -Plus-x$-=$
LUMBER GR.
,r1
FRAMING �� Z
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