9579 (AR)• "
4 4a P.O. BOX 1504 N o . 9579
Building 78-105 CALLE ESTADO
Address 49420 Avenida Club LaQ4,1irT& e.QUINTA, CALIFORNIA 92253
Owner
Mailing
Tom Anton BUILDING: TYPE CONST.. OCC: GRP.
Address same .
A.P. Number
City Zip Tel.
La Qu.inta 1 92253 345-5858. Legal Description
Contractor Project Description PATIO ENCLOSURE
Johnston Constructi6n Company
42430 Tennessee
City Zip Tel.:
Palm Dsrt 92250 3 8
State Lic. City / N
& Classif. B 517491 Lic. t 57
Designer
Address Tel.
City ( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
(,hereby affirm that I am licensed under provisions of Chapter 9 (commencing, with Section
7000),of Divisiioon.3 of -the Business and Professions Code, and my license is iny'full farce and
� -IS NATURE 4 I 1 ' DATE
1< �} OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractors 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 rile 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 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. It, 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 puipose 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.)
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 permil 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
=any person in an manner so as to become -subject to the Workers' Compensation
Laws of•Gahfo\ 41 j' .
Date�.�...•....�
NOTICE 1T AAPPLICANT: If lafterjmakingjthis Certificate of Exemption Tou should become
subject to the Workers' Compensation provisions of the. Labor Code, you must 'forthwith
comply with such provisions or thisp, shall be beemed revoked.
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
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 by:
Validation:
Sq. Ft. 144
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑ Repair O Demolition ❑
Estimated Valuation
9335.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
75.05
Const.
117.00
Mech.
15.00
Electrical
15. 00
Plumbing
S.M.I.
..99
Grading
Driveway Enc.
Infrastructure
`"
�i&Czi75R 7-7;'f'tA (1�! 14
TOTAL
224.C4
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 by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL: SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. @
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ Plus x$
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SQ.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
(C
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING/
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRIN /
111
f
Kd
DUCT WORK
ROCK STORAGE
FOUND. REINF.IAIZ
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
/�
i
,f`
GRADING
cu. yd.
$ Plus x$
_ $
LUMBER GR:
�1
FRAMING L g l
s�
FINAL IN /,r (
�L
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND —7 L
FINISH GRADING
FINAL INSPECTION j q
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIAIS
GARDEN WALL FINAL