10331 (PAT)4
331
P.O. BOX 1504 No. O
Building 78-105 CALLE ESTADO
Address 78--236 Calle Norte LA QUINTA, CALIFORNIA 92253
Mailing •
BUILDING: TYPE CONST. OCC: GRP.
Address 5)Fime
A.P. Number
City
Zip
Tel.
La Quinta
9.2253
564--4224
Legal Description
Project Description
COVER
Contractor
T.A. Kennedy Construction
Address
77350 �Arrcba
City
%a, Quinta
Zip
92253
Tel.:
564-4-664
State Lic.
City
& Classif. 44211t $
tic. # 469
Sq. Ft. 9Q
Size
No. No. Dw.
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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 Py ofoesslons Code, and my license is in full force and
1111.. % ./M•�"�-9ry /'
SIGNATURE `+ - �- "" "- �sT✓+°""'""-'-"' " DATE
`
0' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contrac o
f r's,License Law for the following
reason: (Sec. 7031.5,Buslness 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 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). -
❑ 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.)
Estimated Valuation
7� . 44
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
29.25
Const.
45 j�4
Mech.
Electrical
Plumbing
❑ 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.)
❑ I am exempt under Sec. B. 8 P.C. for this reason
S.M.1.
Grading
Driveway Enc.
Date Owner
Infrastructure
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 J
PlAri fl'i $ 6 A17 {I..91 �
Policy No. Company
❑Copy is filed with the city. ❑ Certified copy is hereby furnished.
i li L i4.1 ti I f t_t i l if_ I i It , 7r
TOTAL
14 ..-:15
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
(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 peon in any manner so as to become subject to the Workers' Compensation
Laws of Cali fornirsa.
Date Owner
NOTICE TO APPLICANT:11, eller making this Certificate 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.
.ZONE: BY:
Minimum .Setback Distances:
Front Setback 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
FINAL DATE
INSPECTOR
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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
'1"
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
FOR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SO. Fi.
WALL SQ. FT. ®
SQ FJ ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
0
YARD SPKLR SYSTEM'
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
//��
"y
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROUGH WIRING.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FOUND. REINF.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
FINAL INSP.
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
l
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEECONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
L
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
//��
"y
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 I qI AA _ / 1 1-19
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING IAIA 41111 L
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSP ECTION•
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
FF
rrr--/7-- --7
nook
master bedroom
kitchen' C
IC
F
rr!
living room
LO
dining room
bedroom 2
0-
M
V OVA
EN
SER
BUILDING & SA
-SUNECT TO INSTALLATION
AND ALL APPLICAMErm
410w. in
bedroom 3
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