05678 (PAT)s� v • ,�/I
P.O. BOX 1504
Building 54-80 QUIM78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
DALT AS ST.OIN
,y SAM
Address "
City Zip Tel. +-
1A QUT=A. 93253 639/554--4412
Contractor
Oil/aBuTLIDn
Address
City lZip
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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. 7031.5,11usiness 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 file a signed statement that hes 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 viWafion of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penally of not more Um live hundred do0ars ($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
builds or improves thereon and who doas such work himself or through his own employees,
provided that such unprovements are not untended or offered for sale. 1r', however, the building
or urrprovement is said within one year of completion, the owner -budder wig have the burden
of proving that he did not build or improve for the purpose of safe.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Prolessions Code: The Comractor's License taw
does not apply to an owner of property who builds or inproves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractors License Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date r'_ ` .r f Owner ir. J st`
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 are 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 toibecome,subject to the Workers' Compensation
Laws of California
Date Owner y'
NOTICE TO APPLICANT: ff, after making this Certfficate 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
1hereby 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.
1 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.
BUILDING: TYPE CONST. OCC: GRP:
A.P. Number 7+69--073-002
Descri
Project DescriptionPATIO COMI
05678'.
FINAL DATE INSPECTOR
4/36/#9
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ 'Demolition ❑
Estimated Valuation
$600.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
25.00
Mech.
Electrical
Plumbing
S.M.I.
.6�7
Grading
Driveway Enc.
Infrastructure
TOTAL
`
REMARKS
' w
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
4/36/#9
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. a $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
2ND FL SQ. FT.
FORMS
YARD SPKLR SYSTEM
POR. SQ. Fr. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. Fr. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. Ff.
OTHER APPJEQUIP.
DRAINAGE PIPING
WALL SQ. Ff.
TEMP. POLE
DRINKING FOUNTAIN
SQ FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. Fr. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
MESH
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 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.
FRAMING b/2��
FINAL INSP.
ROOFING 6/Z� /f��
(' ^ 77� !
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C
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
1
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