003776 (PAT)Building
Address 54-405 Cr,
ama 3''za
Owner
T4hf 4 4Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. �3T76
Richard, R. Pal ortarea
BUILDING: TYPE CONST.
OCC: GRP.
Mailing
Address Dn ROX
A.P. Nuitber
774-242-019
CityZip
Tel.
T.A 011i.`r Z,
11112%51.3
Legal Description
Project Description
rAt io Cover
Contractor _ ''
Address _
City -]Zip
Tela
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
Size 216
No. No. Dw.
Stories Units
Arch., Engr., ..
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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 infull force and
effect.
'
SIGNATURE DATE
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
Estimated Valuation
t"z S`
0
-
PERMIT
AMOUNT
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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
Plan Chk. Dep.
'
Plan Chk. Bal..
'
$25-i.02
Const.
3$ :Q
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
-improves
Mech.'
-
builds or 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.) -
EI2CtfIC81
,
Plumbing
❑ 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 contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec..B. B. & P.C. for this reason
.-
S.M.I. -
Grading
Driveway Enc.
Date `�' v. - i IC Owners f di�� 7 '/i Kms,- ;._. r..,4
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM
W ORKERS' COMPENSATION INSURANCE
REMARKS
(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.
J —t, o' 110 1' .
"�} •. } j 1J'
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.
ZONE: BY:
.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
Lender's Address
FINAL DATE
Issued by:
Validated by:
INSPECTOR
Q)
Date ! Permit
- -
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 lawsrelating 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
Validation:
City, State, Zip
HARD COPY I
T
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. 0
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. 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.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ®c
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 1/4c
HOUSE SEWER
GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES _[__MICRO
FEE
MECH.FEE PL.CK.FEE __jCONST.
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.
W (FRAMING(/- o"% )_ ��
! �
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
GRADING
/FINISH
041NALINSPECTIONV 7
CERT. OCC.
FENCE FINAL -
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL