04169 (PAT)f�1
4
P.O. BOX 1504
Building 80-,131 elm Circle LA QUINTAC
Address CALIFORNIA 92253
Owner
C. 0. W�P11
Mailing
Address Sam
City lZip Tel.
La 0ainta 1 92253
Contractor
Cash Construction _
Address
78-341 Darby Road
City Zip Tel.
Indio 92201 34"-1319
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70mi of Division 3 of the Business and Professions Code, and my license is in full force and
r
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 of not more than five hundred dollars ($500).
O 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 toan -owner of property who builds or improves thereon, and who contracts for
such projects with'a contractors) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date 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
O 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.
Data Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwllh
comply with such provisions or this permit shall be deemed revoked.
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number t -»' '4r f�, -• F��:
Legal Description
Project Description Convert patio
REMARKS M
LV
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
Sq. Ft.
Size 112
No. No. Dw.
Stories Units
New ❑ Add Q
Alter ❑ Repair ❑ Demolition ❑
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATEINSPECTO,RD
� U
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.
Estimated Valuation+
I certify that I have read this application and state that the above Information is correct.
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
4 f* o �
Const.
r:Jir
Mech.
Validated by:
Electrical '
xtli . Vu
Plumbing
S.M.I.
Validation:
Grading
Driveway Enc.
Infrastructure
TOTAL
.1f" d..,dA.
REMARKS M
LV
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATEINSPECTO,RD
� U
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.
41 e 4 r
I certify that I have read this application and state that the above Information is correct.
Issued by:
Date Permit
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENIIQO. - •55E65OR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES 4'
IST FL 50 FT pr S
UNITS
J
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO FT. a
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR SO FT. @
SEWER OR SEPTIC TANK
H WIRING% /� >-
GAR SO. FT. C1
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. SO FT. @
HEATING (FINAL)
WALL SO. FT. @
REINF. STEEL
DRINKING FOUNTAIN
GAS (FINAL)
TEMP. POLE
URINAL
SO. FT. @
GROUT
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as properly tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTONDISH)
'APPLIANCE DRYER
LUMBER GR. (
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FRAMING % q P /�'
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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.
SO. FT. ® c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 11A c
SEWAGE DISPOSAL
SPARK ARRESTOR'
SO.FT.GAR @ 3/� c
HOUSE SEWER
GAR. FIREWALL
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
H 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.
plu5 x$
=$
LUMBER GR. (
FINAL INSP.
FRAMING % q P /�'
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 'Hi ghway • 111` ; . f
`�10TICE: • THIS DOCUMENT CANNOI7idi'o,' CA < 92201
;$
''..CERTIFICATE OF SCHOOL FACILITVFEE WAIVER - *'
T0. '_D ATE
G�
This is to certify, that
' developer of /y, "� whi h is
d. located at ` 0—/3 G.�>� ,within. '
this school district, isnot required'to,pay"•school facility f s
pursuant to'the authority generated by Government Code Section 53080.
i Building permits for the'project•indicated above may-now be issued by your
' • - jurisdiction . �-;- ----•,��-��-�--- - - - _:_..
iIF VALUATION INDICATED ON,,BUILDING jPERMIT 'EXCEED S• $$20, OOO;� >
ITHIS;WAIVER;.'IS• VOID;AND A',SCHOOL` FACILITIES FEE�MUSTQBE _AID�P..RLO.R:TO'
SSUANCE 'OEIBUILD'INGPERMIT'. f.
%for-DESERT-SANDS UNIF D S OL7 ISTRICT-
.White-Building Department Yellow-Facilities Planning Pink-Developer, (10)-38
• •+ + ' • - 1 •t ;1 • • .. I• ,, i i1 � .: a ,