14042 (PAT)Building
Owner
Ti -ht 4.fwQ"
P.O. BOX 1504
78-105 CALLE ESTADO
52-445 Ave. Ber=das LA QUINTA, CALIFORNIA 92253
Fanny Harper
Address same
City
La Quinta, Ca
Contractor
o ne>±/B>tsilder
Zip 92253 ITeI.
City Izip I Tela
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 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 thetapplicant 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-'Ousiness 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 ��,. owner of the property, or my employees with wages as their sole compensation, will
j lite 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
li of proving that he did not build or improve for the purpose or sale.)
❑ 1, 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
I such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
f
O 1 am exempt under Sec. B. & P.C. for>this � on
t �
1 `! '/
f0ate J t Owned
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred,ddljr+rs (8100) valuation
or less.)
I certify that in the performance of the work for which'th si permit is issued, I shall not
employ any person in any manner so as'to'become 9;6bject to the Workers' Compensation
Laws of California.
D,,ate �- �''� Owner
-Ni TILE TO APPLICANT:"If,^after making this Certificate of Exemption you should become
{jsubject 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.
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. 14042
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Patin Cover
Project Description
Sq. Ft. 44Q
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$5,852.00
PERMIT
AMOUNT
Plan Chk. Dep.
_ -
Plan Chk. Bal.
• 00
Const.
• G S
Mech.
Electrical
Plumbing
e
.S.M.I.
•
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS Iwo 1 1
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
•r.
Issued by: Date
Validated by:
Validati
INSP OR
r�mi
f
1 •.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. a $
UNITS
SLAB GRADE
I,n P
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS t
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. I SO. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
a
-$
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
VENTILATION
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 71/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE LPL.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$
a
-$
LUMBER GR.
FINAL INSP.
FRAMING rgy ti�
FINAL INSP.
ROOFING
i
REMARKS:
t '
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
i
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION /s
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Rafter S1se l Spacing
Roof lftch
Contleuoue ltdger
=�1�� ---
Size
Rafter Spat - MAS -
See tooling Mote Below
- tpeclfy� 4 Sheathlne et epen Lattice
2�-�
- - e
/
"Y- and Angle (traps
6-vet-al-sl/6" with J
4-16 d sails or belt
Post .pati:( _
1
enroll Imath —
Ria. 4724" post.
oil
RF�1R, PL StCE
2000 v.s.i. CWCMte J:J
Cio
s12":123/6"zS" leg screws late studs at lio.c. otis= 12"
selo>r Grade
Cootlouous dodger 0 -strop or
Angle
Ron-eorroi
o a ager or Solid tlociclag—I
Mau Iter to uockin(
CWC 1 - W 4 - 16 d salla or bait
- • ni. . 70
ME Mal"OF K=DC lobed Anchors !" to em _ -
rn
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W .S CI go S ��
p b b
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Z
:i2 4
ACL
16 - * C.
24'
'Z
110-6
6-8
7-11
6-5
6-3
6-9
6-4
5-2
2
12" .c.
11-10
L!J
3-0
13-7
10-0
<
O
16-3
15-1
11-3
11-9
ht
(�
0<
U
12-4
9-2
9--7
7-1
I.
32'
LIJ.
9-11
7-6
7-6
5-6
2x8
16' .c.
21-5
LIJ
Cr
3S-"
11-6
LL
ES O
17-6
V
VO
0
>-0
72' -
C)
F-:
134
10-0
0
tii
Rafter S1se l Spacing
Roof lftch
Contleuoue ltdger
=�1�� ---
Size
Rafter Spat - MAS -
See tooling Mote Below
- tpeclfy� 4 Sheathlne et epen Lattice
2�-�
- - e
/
"Y- and Angle (traps
6-vet-al-sl/6" with J
4-16 d sails or belt
Post .pati:( _
1
enroll Imath —
Ria. 4724" post.
oil
RF�1R, PL StCE
2000 v.s.i. CWCMte J:J
Cio
s12":123/6"zS" leg screws late studs at lio.c. otis= 12"
selo>r Grade
Cootlouous dodger 0 -strop or
Angle
Ron-eorroi
o a ager or Solid tlociclag—I
Mau Iter to uockin(
CWC 1 - W 4 - 16 d salla or bait
- • ni. . 70
ME Mal"OF K=DC lobed Anchors !" to em _ -
rn
U)4r L V L
W .S CI go S ��
p b b
rE t 6 aa) Fks• ys•. yb 6.6
Z
:i2 4
ACL
16 - * C.
24'
11-2
9-6
110-6
6-8
7-11
6-5
6-3
6-9
6-4
5-2
2
12" .c.
11-10
17-5
3-0
13-7
10-0
<
16- -
16-3
15-1
11-3
11-9
ht
(�
24"
13-3
12-4
9-2
9--7
7-1
I.
32'
10-10
9-11
7-6
7-6
5-6
2x8
16' .c.
21-5
19-10
14-30
3S-"
11-6
).,
241
17-6
16-3
12-1
12-6
>-0
72' -
11-s
134
10-0
10-2
7-0
1
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gtsafirq Rote
a. Mood sluices 4/12 pitch (3/12 mia. pitch with 3C
felt trtderlay) Class A
D. Mood. ca:;ztsitior. s'e_ncles 4/12 pitrh 43/12 tri:
Pitch oath 151 felt underlay). class A
c. dlc:alt W rolled rco., supe to drai:..
d. A'xk rco` 3/12 mnx:-mr patrn.
I
WpIM PATiV CWLR