002452 (PAT)4
P.O. BOX 1504
Building54-085 Aver � LA QUINTA CAL CALIFORNIA 92253
Address
Owner
Mailing
Address P»� BM 1093
City Zip Tel.
Lift Quirta I V?25. .
Contractor
Address . .
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City Zip State
. . Lic. #
LICENSED CONTRAPTOR'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 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 fhe Business and Professions Code, or that. he is exempt therefrom, and the (iasis
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
buildsor 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 or sale.) -
❑ I, as owner of the property, am exclusively contracting with 1icensed 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.) - -
❑.I am exempt under Sec. -B.
/ B. & P.C. for this reason
Date Owner �.7 r t' � A . o f e" v t, r
Y
WORKERS' COMPENSATION DECLARATION
Ihereby 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. Q 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 thg work for which this permit is issued, I shall not
employ any paon in any manner so as to become subject to the Workers' Compensation
Laws of Cali fornirsa.
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.)
Lender's 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.
1 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. �'�. .R `
Signature of applicant Af ! -! + /'i _ + Date
Mailing Address
City, State, Zip
HARD COPY
No. 002452
BUILDING: TYPE CONST.
A.P. Number 774-•201-017
Legal Description
Project Description 'Patio Omex
OCC..GRP.
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft. -
Size 240
No.
Stories
No. Dw.
Units
New.❑ Add E�e
Alter ❑
Repair ❑ Demolition ❑
Issued by:
Date 7-9-86 Permit
Validated by:
Validation:
A5936
7 9 64,02 CK,
Estimated Valuation
2
[{
424.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
25.02
Const.
38.50
Mech.
Electrical
Plumbing
S.M.I.
R
Grading
Driveway Enc.
Infrastructure
TOTAL
€4.07
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 7-9-86 Permit
Validated by:
Validation:
A5936
7 9 64,02 CK,
CONSTRUCTION ESTIMATE I NO. I ELECTRICAL FEES I un I of Iluolur_ cccc
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. p
POR. SO. FT. ®
GAR. SQ. FT. @
CAR P. SQ. FT. ®
WALL SQ. FT. ®
SO. 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
COLL. AREA
FLOOR DRAIN
MECHANICAL FEES
BONDING
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)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEOUIP.
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.
SQ. FT. ® c
BATH TUB
GRADING
cu. yd.
$ plus x$
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.TU.
SO. FT. RESID @ 11/e c
SEWAGE DISPOSAL
FINAL INSP.
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEEPL.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
ORMS l�
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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.
4FRAMING /
FINAL INSP.
,ROOFING ¢�
VENTILATION I/
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
-
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
14/FINAL INSPECTION
CERT. OCC.
FENCE FINAL
VM J aIU-M 1 Yr1C011MI I IAL.1,
GARDEN WALL FINAL
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