PAT (10-1064) + PLBG (08992) + BLCK (003631)54414 Avenida Martinez
10-1064
08992
003631
P.O. BOX 1504 _
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00001064
Property Address:
54414 AVENIDA MARTINEZ
APN:
774-254-007-12 -000000-
Application description:
PATIO COVER - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
5905
Applicant: Architect or Engineer:
.4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
LICENSED CONTRACTOR'S 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 Class:- License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5. Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
ypplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: -The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: /-
LQPERMIT
Owner:
WENCESLAO RAZO
54-414 AVENIDA MARTINEZ
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/13/10
------------------------- ----- D
Contractor: L I 142
Owner
CITY OF LA QUIN*rA
--------------- - - -
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
_ I havi: 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 and policy number are:
Carrier Policy Number _
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 provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
ate: q / 'N pplicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned proppert/y//,/{or inspection pu poses.
ate: 6— i3- Si ature (Applicant or Agentl:- / ial
Application Number . . . . . 10-00001064
Permit . . . PATIO COVER PERMIT
Additional desc . .
Permit Fee . . . . 81.00 Plan Check Fee .
Issue Date . . . . Valuation . . . .
Expiration Date . . 4/11/11
52.65
5905
Qty Unit
Charge Per
Extension
BASE FEE
45.00
4.00
9.0000 THOU
BLDG 2,001-25,000
36.00
----------------------------------------------------------------------------
Special Notes
and Comments
444 S.F. SOLID
PATIO COVER,
CITY
STANDARD. 2007
CODES.
-----------------7----------------------------------------------------------
Other Fees
. . . . .
. BLDG STDS ADMIN (SB1473)
1.00
STRONG MOTION (SMI) - RES
.59
Fee summary Charged
Permit Fee Total 81.00
Plan Check Total 52.65
Other Fee Total 1.59
Grand Total 135.24
LQRERMIT
Paid Credited Due
.00 .00 81.00
.00 .00 .52.65
.00 .00 1.59
.00 .00 135.24
N 216 A
J
s
1 /e ✓t Les z u
5 y-y f Ave✓ i ez
L cz Q 912 2q'3
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE
KV ILH SIZE AND SPACING,
zZ`-6-- —2—`'
ROOF PITCH
Commoom
(SAW SIZE AS
HEADER S4 0
-- xSPAN:
2000 Ps.1 CONCR@tE - --; " ' I F1ras
J
SPECIFY ROOFING AND SHEATHING OR OPEN LATTI:.E
(SEE ROOFING NOTE ON REVERSE)
` T ANO 'l' STRAPS I
s'w1trxt/e' WITH
z I rt (4) 164 NAILS OR DOLT
/s
rJ POST SP ; /_- /y
—
3 —8
I p _ 0
pp sm. 6 x-(
ff RAM
sm soup=
ADE FINISH BOE
Itr DEli * CRADE L --.j
PROVIDE f CLEARAKE
BETWEEN POST AND.
a'EA LATTICE PATiO COVERS MAY BE ATT CONCRETE
VIA ONE 1/` * S LING SCREW ATTACHED TO+E , i FASCIA
tNR0UG11 fASCN 'INT 1. ITER TAS
3/Ar r S USC SCREIn INTO STUDS AT 15' O.C.
/—' CommoUs LFOCER /
— "Sr- NANCER OR SOLO DLOCIMC
MAIC RAFTER TO 8lpppNQ
U—STRAP OR ANGLE
.NON—CORROsNE PW1TE
. -
(4)— 16d NAILS
1
OR BOLT
U—STRAP OR ANGLE
(4)— 16d NAILS
OR BOLT
PROVIDE t" CLEARANCE
BETWEEN POST AND
CONCRETE
I
ANCHOR BOLT (EMBED
T MIN. INTO CONCRETE)
TYPICAL PATIO COVER
DATE OF APPLICATION
OWNER'S NAME
STREET ADDRESS
CITY. ST ZIP
TELEPHONE
HAA APPROVAL
i
Q• Q. Q.
v Q- v v
RAFTER SPAN TABLE. ` " pp°
GRADING .RULES 07 s' ALL CONSTRUCTION SHAI,L CONFORM
PS 20=70 o mac, ' os ° TO THE. PROVISIONS OF THE :.
(FEET & INCHES) ` oJ `7
o o
2x4
16' O.C.
24'
10'-
8'-6"
9'-
-n
7
-0"
T-3`
S17= SPAN
SIZE SPAN
2x6
16' O.C.
24'
3Y
i
4X6 6'-0
4x.8. 11'-0
4x$ g•_0
10'- ---IVAN
A
4x 12 17'-0
4x 1.2 t ,-•0
24
1C. O.C.
24'
32.
-
1 '
t
•_
NOTES:.
1. 32" RAFMA SPACING IS ALLOWABLE
FOR OPEN LATTICE PATIO COVERS ONLY.
2. FOR SOMPAT10 COVERS (NOT LATTICE)
RAFTER $PAN 4S' L-IMFTIED T0.10'=0" USING
THIS Sj-*4DARD.
LATTICE ROOF "BUILT-UP
ROOF
HEADERS
HEADERS..
DOUGLAS FIR NO. 1
DOUGLAS FIR NO. 1
S17= SPAN
SIZE SPAN
4r.4 -0"
4x4 4•_0"
4x6 $'-0"
4X6 6'-0
4x.8. 11'-0
4x$ g•_0
4x10 14'-0
4x10
4x 12 17'-0
4x 1.2 t ,-•0
.6x8 14'=0"
6x8 12, -0"
6x10: tT'=Q
6x10 t4'-0"
ROOFING NATES:
A. BUILT. -UP. ROLLED ROOF: SLOPE TO DRAIN.
B. ROCK ROOF:. 3/ 12 ..MAXIMUM PITCH.
y1
'A .•
P.O. Box 1504
LA'QUINTA; CALIFORNIA 92247-1504
78-495 CALLE TAMPICo
LA QUINTA,' CALIFORNIA 92253`
,('aQr ra
BUILDING & SAFETY DEPARTMENT
PROPERTY OWNER'S PACKAGE
(760) 777-70.12
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
INI-e -TAN ! NOTICE TO PROPERTY 0VVWK
Dear Property Owner.
An. application for a building permit has been submitted in your name listing yourself as the builder of the .property
improvements specified at
We are .pmviding you with an Owner -Builder Acknowledgment and Information verification Fort. to make you aware of your
responsibilities and possible risk you may incur by having this.permit•issued in your name as the
Ownes-Builder. We will not issue;i building perrmit until yowltave read; initialed yourunderstanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute thi¬ice
unless you, the property owner, obtain the prior approval of the permitting authority.
OVA'S ACS=LI)QM—, iT ATION OF II O TA`I`l1OAi
DIIiEE YOKS. Dead and'initial each: statement-8etow to signify you understand or verify this information.
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or her own labor and material personat# i. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her.employees while working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am willfully acting as an Owner -Builder and am aware of the limits of.my insurance coverage for injuries to workers
on my Property
2. I understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility..
_3. I understand as. an "Owner -Builder" I am the- responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
4. I understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction isat least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
6. I understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide wocicerscompensation disability insurance, and' contribute to unemployment
r compensation for each "employee." I also understand my failure to abide by these laws may subject nie to serious financial
risk
7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential
structures cannot .legally build them with the .intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
A
8. I understand as an Owner -$wilder if I.sell the property for which this permit is issued, I may be held liable for any
financial or personal. it;l.ades sustainedby any subsequent owner(s) that, result from any latent construction defects in the
worlananship or materials.
9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue
Service, the United States Small Business Administration, the California, Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS I.B) at I-
800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors.
l0. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the
party legally and f nancially responsible . for: proposed construction activity at the following address:
_11-I agree that, as the party legally and financially responsible for thisproposed construction activity, .l will abide by all
applicable Paws and requirements that govern Owner -Builders as well as employers.
12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on, this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not bave a license,. the Contractors' State License Board may be unable to.assist you with any financial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be inieivil court: It is also
important for you to, understand that -if an urdwensed.Contractor or employee of that individual or firm is injured while woddng
;
on your propertyyou may be field liable for damages. If you obtain a permit as Owner -Builder and wish to hffe Contractors,
you will be responsible• for verifying whether or not those Contractors are prope€ty licensed and the status of`thoiF workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and returned to
the agency responsible for issuing; fhe:permtiL Now A copy of the property orvner•'s dkiversli eame; form no(11*01nr or
other verification acceptable to the agency is required to be presented when. the permit is issued to verify the property
owner's signature. '
Signature of property owner w Date
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OVMNER'S BEHALF
Excluding. the Notice to Property,. Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act a5 my agent(s) to apply for, sign,. and file the documents necessary to obtain air Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tet No
I declare under penalty of perjurythat I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required to be presented when the permit is issued to verify the property owner's signature..
Property Owner's Signature: Date:
Bin #
City Of La Quint
'a
8T Safety Division
Box 1504, 78-495 .Calle Tampico .. •.
La Quinta, CA 92253 - (760).777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
I . O
.--
.„ E Ja aZ tet Addess:yPoju s.Vners Name:
A. P. Number: . , - dress: j y/ 1 / /4..✓•e . , I A. m ti ' : 12
Legal Description: . wity, ST, Zip: L c, '.t A
Contractor:, 2 Telephone:
Address: roject Description: C, f
'City, ST, Zip:'.. 7
Telephone:,
State Lic. #.a City Lic. #;
Arch., Engr., Designer
Address:
r
City.; ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: _ Sq. Ft.: qqq I# Stories: ' ` #Units:
Telephone # of Contact Person: stimated Value of Project:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
# •
Submittal
Req'd
Recd
TRACKING'
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, readyfor corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'" Review, ready for correctionsassue
Electrical
Subcontector List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
7n° Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A,LP,P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Ti`ht 4 4 Q"
Building
Address 54-414 Ave. Martinet
Mailing
Address
++w
City I Zip ITel.
Contractor
$ tlt r CSOii construction
Address
P.O. Box 1908
ity lZip Tela
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City (Zip (State Lic. # r- __ _ .
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed underrprovisions of Chapter 9 (commencing with Section
7000) of Division &of a Busine sand Professi s -Code, and my license is in full force Ad
effect: / 7 1 J( r
SIGNATURE t... "•.. v r +i"'" .r tac... „v' ...! +'--' rDR Tib
,qy,:, OWNER -BUILDER DECLARATION
I hereby affirm that I 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
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
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
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply 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 sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of 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-
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
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & 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
❑ Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 the work for which this permit is issued, I shall not
employ any parson 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
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days. .
I certify that I have read this application and state that the above information is correct.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 08992
BUILDING: TYPE CONST. OCC. GRP.
.P. Number 244._2!54==
Legal Description
Project Description A1%%►?rs*1m. S=1 -4t A, se2mr
Sq. Ft.
Size
No.
Stories
New ❑ Add ❑ Alter ❑
EstimateO Valuation
No. Dw.
Units
Repair ❑
Demolition ❑
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 30.00
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
30. (Ohr i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. 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 1
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
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
GAS (ROUGH)
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE:d I
I 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.IEOUIP.
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
"v
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL
42:bnc-,z -
Bujldjt3
Arm raceg4-4x4 Iiarti.nez
P.O. BOX 1504 No, 0036301
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
OwnerManuel Diaz
I
Address Same as above
City Zip Tel.
Ta .10nnta 5i225'A 36.4-5157
Contractor
owner/ Builder
Address . .
Zip I Tel.
State Lic. I City
& Classif. Lic. #
Arch.- Engr.; '
Designer
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
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, aker, 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
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.
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
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not'apply 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 sale. If, however, the•building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or Improve for the purpose of sale.)
❑ I, is 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
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec..B. B. & P.C. for this reason
Date ' fi f r k 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
O Copy is filed with the city.. O Certified copy is hereby furnished. .
CERTIFICATE OF EXEMPTION FROM
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 tha 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
subject to the Workers' Compensation provisions of the Labor Code, you. must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.) -
Lenders Name
Lender's Address
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.
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.
Signature of applicant Date
Mailing Address
City, State, Zip
HARD COPY
BUILDING: TYPE CONST. - OCC: GRP.
A.P. Number 774-254-007
Legal Description
Project Description Wcuma Penne 51, h-tah X 2506 1. ng
ZONE:
BY:
Minimum Setback
Distances:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
6ate2/11/ Permit
Validated by:
Estimated Valuation
PERMIT
+- AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const
.
Mech.
Electrical
Plumbing
S.M.P.
.50
Grading
Driveway Enc.
Infrastructure
TOTAL,
/i<a
REMARKS
ZONE:
BY:
Minimum Setback
Distances:
Front.Setback.from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
6ate2/11/ Permit
Validated by:
Validation -
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 APPJEQUIP.
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 SIGNATURES11NITIALS
GARDEN WALL FINAL