03906 (PAT)Tityl 4 4. Q"
P.O. BOX 1504
Building 76=685 SAGUARO DRM78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address SAMB 617-383-018
A.P. Number
City lZip ITel.
LA QUT,N: A 1 92253
Contractor MER/BUMER
AaaressSAM
I
Zip
State Lic. City
& Classif. Lic. #
Arch., Engr.J
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 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 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 ofnot more than five hundred dollars (8500).
❑ 1, 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.)
❑ 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.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date ��� • ' "' y'. Owner
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. O 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 ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this 'Certificate of Exemption you should become
subject to the Workers' Compensation provisions & 'Ihe, Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
7
CONSTRUCTION -LENDING -AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name -
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above Information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Legal Description
Project Description PATIO Icown.
390
Sq. Ft. No. No. Dw.
Size . Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 350.00
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk: Bal.
Const. 2000
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
�1�A USM) i 13
ZONE: BY:
Minimum Setback Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop,., Line _
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 4/29/a$ Permit
Validated by:
Validation:
WHITE - FINANCE, PINK APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
UNDERGROUND,
A.C. UNIT
COLL, AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO FT. a
BONDING,
MOBILEHOME SVC.
BAR SINK
POR SO FT. at
--SEWER OR SEPTIC TANK
;Ii6U�G"H'. WIRING
POWER OUTLET
ROOF DRAINS
ROCK -STORAGE -
FOUND. REINF. f
GAS(ROUGH)
METER LOOP
DRAINAGE PIPING
CAR P. SO FT. ra
HEATING (FINAL).
OTHER APPJEOUIP.
-REINF. STEEL
GAS (FINAL)
EMP. POLE
URINAL
WATER �6TER
SERVICE
'ESTIMATED CdII%iSTFIUCTION`VXCLIATION
WATER PIPING -
NOTE: Not to be used as properly.tax valuation
-.BOND.BEAM
FLOOli DRAIN
MECHANICAL FEES
WATER SOFTEkR'
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISHi
APPLIANCE— DRYER
GARBAGE DISPOSAL
FURNACE,
FINAL INSP.
LAUNDRY TRAY_
AIR HANDLING UNIT CFM
1 11:7
KITCHEN SINK
ABS&07idti SYSTLIW' -13. T..U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HtATI-146'��STEM 'FORCED GRAVITY
AMPERES SERV ENT
SHOWER
GAR. FIREWALL
SQ. FT. c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1 1A c
SEWAGE DISPOSAL
MESH
SO.FT.GAR 3/,c
HOUSE SEWER
GAS PIPING"
PERMIT FEE
PERMIT FEE
PERMIT FEE
DEL
70TAL FEES—
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
S MI F EE PLUMB FEE
`
-----urnuerupE--�—,— — � pmwmwu' ELECTRICAL HEATING xAIR COND. ' xoL^n .
SETBACK—
GR6UNb PLUMBING
UNDERGROUND,
A.C. UNIT
COLL, AREA
SLAB GRADE
ROUGH PLUMB
BONDING,
HEATING (ROUGH)
ST60RAGE TA:NK
--FORMS
--SEWER OR SEPTIC TANK
;Ii6U�G"H'. WIRING
DUCT WORK
ROCK -STORAGE -
FOUND. REINF. f
GAS(ROUGH)
METER LOOP
HEATING (FINAL).
OTHER APPJEOUIP.
-REINF. STEEL
GAS (FINAL)
EMP. POLE
GROUT
WATER �6TER
SERVICE
FINAL INSP.
-.BOND.BEAM
WATER SYSTEM
S—Plus—xs—=$
GRADING
cu.yd.
LUMBER'GR.
FINAL INSP.
FINAL INSP.
060046-
1 11:7
REMARKS:
FIREPLACE
GAR. FIREWALL
LATHING
MESH
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
I