14677 (PAT)414
t P.O. BOX 1504 No. 1 4 6 7 7
Building 52-100 Ave. Rubio 78-495 CALLE TAMPICO
A. dress LA QUI NTA-, CALIFORNIA 92253
Owner Janew Belk zaap _
BUILDING: TYPE CONST, ,, • OCC: GRP.
Mailing Same-
Address
City Zip Tel. - ..
A.P. Number
Malm..Desext,. 92.260 Legal Description '
Contractor (2)., a attice Patios
},3f3�.I nap Construc tion Project Description
Address
P.Q. Box 297
Paz
Citylm Desert,_ Q ip 92268 Tel
State Lic. City
& Classif.. 652.15 Lic. # 2845 ,.
- Sq. Ft. .. No. • . No. Dw.
240• Stories. . -
Arch:; Engr.,. Size Units.
Designer New ❑ Add ❑ Alter ❑ Repair ❑ - -Demolition p
Address Tel.
City . Zip State P
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section' • + -
000) of Division 3 of the Business and Professions Code, and my license is in full force and
ffect:
SIGNATURE DATE
_'
OWNER -BUILDER DECLARATION
Estimated Valuation$3,,,1.9.2.00 A
I hereby affirm that I am exempt from the Contractor's License Law for the following ,
reason: (Sec. 7031.5,Busfness and Professions Code: Any city or county ,which requires a --
1 , permit to construct, atter, improve, demolish, or repair any structure; prior to its • issuance also • - • m -
i requires the applicant for 'such permit to file a signed statement that he is licensed pursuant to : PERMIT `
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of. - ,,AMOUNT - , -
r: N 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). -
�,b. I, as owner of the property, or my employees with wages as their sole compensation, will. Plan Chk. Bal. 40.95-'
do the work, and the structure is not Intended or offered for sale: (Sec. .7044, Buisness and • COr1St. �b 00
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,
Mech. -
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 Electrical
i;- o! 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
slrucl the project. (Sec. 7044, Business and Prolesslons Code: The Contractor's License Law
'does not apply to an owner or property who builds or improves thereon, and who contracts for S.M.I. • -" • - .32'
such projects with a contractor(s)(icensedpursuant to the Contractor's License Law.) .
Grading
❑ 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc. r1
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have -a. certificate of consent to'self-insure, or a certificate"of
Worker's Co pBnsation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) -
Policy N . company
IaOCopy is filed with the city. ❑ Certified copy is hereby furnished. - - -
TOTAL 104.27 '
CERTIFICATE OF EXEMPTION FROM REMARKS c
• 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 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
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
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL"",'AND'
Side Street Setback from Center Line
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,
'Side Setback from Property Line—
DAMAGES AS PROVIDED FOR IN SECTION 3706'OFTHE LABOR CODE; INTEREST, AND
-
-
ATTORNEY'S FEES. - -
-
This Is a building prm
eit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
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.
ISSUed by:
Date r-
-Permit:. --I agree to comply with all city and county ordinances and state taws relating to building
construction, and hereby authorize representatives -of this city to enter. the above -:.-
1nn1
mentioned property for Inspection purposes. '
Validated by:
Signature of applicant Date'
!
Mailing Address
Validation:
R
City, State, Zlp
— v
T,
By�M___ ;
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
J
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DRAINAGE PIPING
WALL SO. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
x$ =$
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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 ELECTRICAL HEATING & AIR GOND. 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 APPJEOUIP.
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
_ - ^
�,7o
REMARKS:
VENTILATION
}nom
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
(
see iooflna Mote Ulor
8pac14 Soollta a Sheat lar atChet Lattice
A.
2000 V.S A. F -:J
Itis . 12'a12"
Ioocia= 12'
�!/i"s!" lei aerees foto atwis at IS- •.e. klw Crade
Caotlouo" {other 0-atr90 or
1
Provide 1"
i learanc
ost To
Joist Danger or Solid Sloctiai Concrete
Gail 4fter to ilotiiniA lilt
�, C -S n— W - li t uila Sol
shMU MMP Zo
Mar lurs>MK4 am = Imbed Anchor. V in eaac.
cmc .—. It C
L_.1
Is
FAMM SPAN asp
llradi.-q lades
PS 20-;0
(feet a IzLhas)
2x1
16- O.C.11-2
21- •
9-0
10-6
8-6
7-11
6-5
6-3
i-!
6-1
5-2
2Xd
12" c.c.
17-10
17-5
13-0
13-7
10-0
woe-eorrasli�:�
16' `
16-3
15-1
I1-3
11-9
H
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2/' •
13-3
12-4
9-2
9-7
7-1
� - Mil �I�
32' •
10-30
1-11
7-0
7-6
S-0
2x4
16 o.c.
21-5
19-10
11-10
35-�
11-0
21•
17-6
16-3
12-1
12-5
1-•i
32'
11-5
134
1D-0
1D-2
7-0
c;&'T 4
(0250 14 3 )c .21$7,
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a. WOW shakes 4/12 pitch (7/12 Min. pitch with 301 .
felt ts+de_ lay) class A
D. WOW. Mpnitioe. e.Ln;les 1/12 pita % 13/12 tri..
Pitch v:th 151 telt u-Ar--layl. Class q
c. f:lt up rolled roof s1cpe to drag..
d• lock roof 3/12 msx_Zn etch.
7WIM PATW = R
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,jil,JECT TO tN�,
DATE
CODES
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Bin #
City o f La
Building a Safety Division
P.O. Box.1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
t Building Permit Application and Tracking Sheet
Permit #
A
Project Address: 100 iaA4 l
Owner's Name:
A. P. Number:
Address: ,.-�,b
Legal Description:
City, ST, Zip: LA-. Q u tl^4 , C•
Contractor:
qry��-.. ��'.�..€
Telephone: I5 ,., 01
Project Description:
Address:
City, ST, Zip:
GfR
Telephone:
I
� "
State Lic. # :
City Lic. #:
t
Z. 2 .• 12�Car,..,•.
Arch., Engr., Designer:
11
Address:
City, :ST,Zip:
G IZttl�53
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
•:#
Stories:
-Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd .
Rec'd
TRACKING .
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed,.ready for correctionsPlan
Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Iiiechanical
Grading,plan
V Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
$.M.I.
H.O.A. Approval
Plans resubmitted .
Grading
IN HOUSE:
''"Review, ready for correctionstissue
Developer Impact Fee.. ;
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees . .. .
ITY
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BY POOL AREA TO BE' ENCLOSED
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RI TO
BE ' ENCLOSE® By
S �
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U j 5 FT . HIGH FL
POOL �
MIN-IMUiA 5 FT. FENCE.
S ELF -CLOSING
T
ES
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ALL,,GATES "' 0 BE S
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AND SELF-�-� ;CHING.
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