002984 (PAT)P.O. BOX 1504 , No.. 00294
Building .78-105 CALLE ESTADO
Address 78-202 'CSE: N=te LA QUINTA, CALIFORNIA 92253
Owner .... .. .. , _ _ ... ..._ ..... _ .. ... . .
Mailing
Address PO 0. BM 1000
City Zip Tel.
.. La - Qom# CA 32253. 345-5665
Contractor
Address... _
BUILDING: TYPE CONST. •VN
OCC: GRP:_
A.P. Number' 769-022"007
Legal Description
Project Description Patio
' City
Zips
Tel:
i, ame
State Lic.
City
& Classif.. 41.3}363
Lic. # 133
Sq. Ft yt
Size -
No. No. Dw.
Stories Units-
Arch., Engr ; . _ .. _ .. .. ...
• Designer
New Q Add :&
Alter ❑ Repair ❑ Demolition ❑ .
Address
Tel.
City
Zip
State
..
Lic. # _
r LICENSED CONTRACTOR'S DECLARATION
- ,
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing -with Section
r 7000) of Division 3 of the Business and Professions Code, and my license is in full force and'
effect..
_
SIGNATURE .i- DATE
' OWNERaBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following�i�(;
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 rile a signed statement that he is licensed pursuant 'to
the provisions o/ the Contractor's License Law, Chapter 9.(commencing with Section -7000) of
- Division 3o/ the Business and Professions Code. -07 That. he- is exempt !herefrom,"and the basis•
for the alleged exemption. Any violation o/ Section 703 L.5 by 'any applicant. for a permit.•
• • • subjects the applicant to a civil penalty of not more than live 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. (Seca 7044, Buisness and3�sJ�!
_ Professions. Code: The -Contractor's License Law does not apply to. an owner o/ 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,
Estimated Valuation
•
p
- ' ' -
- .• PERMIT•-
.. - - - - ,.. ,
'` "AMOUNT
-
Plan Chk. Dep.•-
-
Plan Chk.. Bal...
.36. J2.
COr1St. -
'
Mech. -
"Electrical -
- or improvement is sold within one year o/ completion, the owner -builder will have the'burden•
of proving that he did not build or improve.lor the purpose of sale.) a-
Plumbing
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- -
slruct 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 I am exempt under Sec. B. t: P.C. for this reason
S. M. I.
LL[n1
9 • - w.icl
Grading
Driveway Enc.
.
Date owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
' 1 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
I] Copy is filed with the city. . ❑ Certified copy is hereby furnished.. ,
TOTAL
•
CERTIFICATE OF EXEMPTION FROM
t , , WORKERS' COMPENSATION INSURANCE..
REMARKS
(This section need not be completed if the permit is /or 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' Compensatidn+
Laws of California.
" 'Date _ Owner '
NOTICE TO APPLICANT: if, after making this Certificate o/ Exemption you should become. •.•
' subject to the"Workers' Compensation provisions or the Labor Code, you must forthwith -
. comply with such provisions or this permit shall be deemed revoked.-
ZONE: - BY:•
.Minimum Setback Distances: '. - '
Front.S,etback'from Center Line
Rear Setback from Rear Prop. Line
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') -' - '
-
Side Street Setback from.Center Line
Side Setback from Property Line - -
Lender's Name
_ -
_ DATE
.Issued by- -
- -
Validated by:
-
INSPECTOR
.y'1 q 1 f
Date .t'j•, Permit
Lender's AddressFINAL
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 altcity 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
Validation:
A511
3 iz 9372-11
..
City, State, Zip
HARD COPY
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. Ff.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
ROCK STORAGE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APP.IEQUIP.
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
WATER SYSTEM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/aC
HOUSE SEWER
FINAL INSP.
ROOFING
GAS PIPING
PERMIT FEE
to
I
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.IEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$
_$
BE GR.
FINAL INSP.
AMING �j
FINAL INSP.
ROOFING
��p s
C
DEC '%
to
I
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
1 VM'b biuriA 1 UMCbnrm 1IALb.
GARDEN WALL FINAL