11676 (PAT)(V�
4
P.O. BOX 1504 No. 11676.
Building 50 -550 -Calle QLi] nto78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Jose Garza
Mailing
Address Sate
City Zip Tel.
La Quinta; CA 92253 564-1288
Contractor
Owner/Builder
Address
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
70 OO) 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 Lawfor 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 the Business and Profession's 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, 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 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 of sale:) ..
O 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 under Sec. B. & P.C. for this reason
'c
G �-
Date Owner -
i:
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 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
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
subject to' the Workers' Compensation provisforis of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby 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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Patio cover 14 X 24
ZONE-
BY:
Sq. Ft. 336 No.
Size Stories
No. Dw.
Units
New ❑ Add' Alter ❑
Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side.Setback from Property Line
FINAL DATE
INSPECTOR
Issued.by:
Date Permit
Estimated Valuation
PERMIT
AMOUNT
Plan Chk. Dep.
.Plan Chk. Bal.
46.80
Const.
Mech. '
Electrical
Plumbing
S.M.I.
. SQ
Grading
Driveway Enc.
Infrastructure
TOTAL
119.30
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 bye
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES r
1ST FL. SO. FT.® $
UNITS
COLL. AREA
2ND FL. SO. FT. ®
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK y
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. ®
DRINKING FOUNTAIN.
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$_=
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY .
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
FIRE ZONE ROOFING:
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SPARK ARRESTOR
SO.FT.GAR ® 3/ac
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 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./EOUIP.
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
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIAIS,
GARDEN WALL FINAL
r
iOITY OF LA QUINTA
BUILDING & SAi=ETY DEPARTMENT
- CONDITIGNALLY
A CFPTED FOR CONSTRUCTION
SUBJECT TO INS i AI LATION AS.PER
AND ALL APPLICABLE CODES
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CITY OF LA QUINTA
BUILDING & SAF=ETY DEF)AR T MENT
COi4DIT; ONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INS T ALLA T iON PER
AND ALL APPLICABLE CODES
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DATE BY
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CITY LA QUINTA
BUILDING & SAFETY DEPARTMENT
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SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
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