09180 (PAT)Building
Address 79.
Owner
Mailing
Address SAME
City
i LA QUINTA,CA
Contractor
Address . .
4
P.O. BOX 1504 N o , fl9180
78-105 CALLE ESTADO
01
• LA QUINTA, CALIFORNIA 92253
ENCLOSE PATIO — REMODEL
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Zip Tel.
92253
Zip
` State Lic. I City
' & Classif. Lic. #
Arch., Engr.,
Designer
P Address Tel.
City I Zip I 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, after, 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).
as owner of the property, or my employees with wages as their sole compensation, will
o 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 or 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
I does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
i Date- -Owner / -T %✓
y.r �-
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. ❑ 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 person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner RT.' PUBLIC INS •
NOTICE TO APPLICANT. If, after making this Certificate or 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.
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
Legal Description
Project Description - ENCLOSE PATIO & ENLARGE
BATIROOM AND MASTER BEDROOM
Sq. Ft. No. No. Dw.
Size . '� Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$30,841.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing ,�Fa
13.00
S.M.I. i~,.
'` 2.17
Grading ��'�#:'" 4.1J-:'
Driveway Eno. "
Infrastructure
Leas acctpa
d—Permit fO9169
134.07
TOTAL
Balauee +stile
363.25
REMARKS.
?'•tY.tF.1C{f�r•.�+1..F.+li�,P.T:S4Koi�`�f ...�4Q:�: q-f^o !:'1'. �•i['���
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:
T
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. ®
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP.IEOUIP.
DRINKING FOUNTAIN,
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PPL.CK.Fd
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 3 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$
x
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
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
DESERT SANDS UNIFIED SCHOOL DISTRICT
82-879 Highway 111
NOTICE: Indio, CA 92201
Document Cannot Be Duplicated (619) 347-8631
Date 1/29/91 1 Type of Permit I La Quinta
No. 110394 Permit #
Log #
Owner Name Tadros Tadros
No. 78-170 street Calle Cadiz
City La Quinta zip 92253 Study Area 115
APN # I I Tract # I Lot # Square Footage 1632
Type of Development Residential Addition I No. of units
Comments F.nelnca nntin Rr anlnrara hnt.hrnnm nnri mnctar harlrnnm
At the present time, the Desert Sands Unified School District does not collect fees on
garages/carports, covered patios/walkways, residential additions under 500 square feet,
detached accessory structures or replacement mobilehomes. It has been determined
the above-named owner is exempt from paying school fees at this time due to the
following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of FE -5 8-1 X ® or $ 998.56 have been paid to D.S.0 S.D. for
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By Tadros A. Tadros/Elaine Tadros
Name on the check
Richard M..Beck
Director, Facilities Planning & Development
Telephone
.i iZ� �r
s: ,
Fee collected /eze pted by Shelley D. Bennett
Payment V.6'ceived, �" y
Signature �' Check No .1658
Collector: Attach a copy of County or City plan check application form to District cony:
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
i
4
P.O. BOX 1504 APPLICATION ONLY
Building�7 7&105 CALLE ESTA50— CFS C
AddresLA QUINTA, CALIFORNIA 92253
Q
Owner — — _7_7— e - f- I_
BUILDING: TYPE CONST:'
Mailing Q
Address 7� A.P. Number.
C}ty Zip Tel.
2_212 Legal Description
Contractor ` Project Description;'' /!
ddress n� / --
City Zip TeJ� '
�G o y
State Lic. City
Lic. # Sq. -Ft. �(� % No. No. Dw.
Size / i Stories Units
Arch. mgr.,
Desig r New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
' o
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1A'er�p�( affirm that I am licensed under provisions of"Cha _' 9 (commencing with Section
7000) iff D}vision 3 of the Business and Professions Code, ani my license is in full force and
effect. It-_
S G rQ R DAT \
OWN -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the. following
reason: (Sec. 7031.5,Buslness and. Professionsp.Code:-Any city,or county, which requires a
permit to construct, aftef,'fTOrove, degtotish 45' -?Pair any stiuctureXpri—to its issuance also
requires the applicant"for Such'-peWW toyfle�a `sfgrfed statement the;
1 i licensed pursuant to
the provisions of the Contractor's License Law, Chapter 8 (.0mmencing with Section 7000) of
Division 3 of the Business and Professions Code° or that.he Is exempt therefrom, and the basis
for t�alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
snub acts the applicant to a civil'pehalty of not more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will
o°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
orImprovement i's 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt undti&c l i ! 2r I13.18 P.C. for thiereason
.i. .� ter_.
•y/ QQ ,, �'""'''�,�Yti its .- :� �— i �: `'i •°
Date—_Z -Owner
.0
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 it the permit is for one hundred dollars (S100) 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 tg become subject to th Workers' Co nsation
Law of California.
'
�Dat� E TAPPLICANT.
Owner r`�
NOTICE TO If, after making ,this Certificate of Exemptio 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 car illy that 1 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
ate•Mailing Address
City, State, Zip
BUILDING DIVISION
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:
3tim ted Valuation
�M O
l/4 ,
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
$'
r
Plumbing
S.M.I.
Grading
-Driveway Enc.
Infrastructure
TOTAL
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:
CONSTRUCTION ESTIMATE
GROUND PLUMBING
NO.
ELECTRICAL FEES
NO. PLUMBING FEES
$
3 40
BONDING
UNITS
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
1ST FL. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
2ND FL. SO. FT. ®
REINF. STEEL
GAS (FINAL)
TEMP. POLE
YARD SPKLR SYSTEM
GROUT
WATER HEATER
q q
O O
MOBILEHOME SVC.
BOND BEAM
BAR SINK
POR. SO. FT. ®
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
GAR. SQ. FT. @
ROOFING
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DRAINAGE PIPING
WALL SQ. FT.
FIREPLACE
DRINKING FOUNTAIN
SPARK ARRESTOR
SO FT ®
GAR. FIREWALL
URINAL
ESTIMATED CONSTRUCTION VALUATION- $
MESH
WATER PIPING
INSULATION/SOUND
NOTE: Not to be used as property tax valuation
FINISH GRADING
FLOOR DRAIN
MECHANICAL FEES
CERT. OCC.
WATER SOFTENER
FENCE FINAL
VENT SYSTEM FAN EVAP.COOL HOOD
INSPECTOR'S SIGNATURESIINITIALS
SIGN
WASHER(AUTO)(DISH)
GARDEN WALL FINAL
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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 ® 11/4 c
A0ToI
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
A4T—
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE
PL.0 .FEE
CONST. FEE
ELECT. FEE
SMI FEE
PL MB. FEE
3Pa�
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 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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
r
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL