10590 (PAT)P.O. BOX 1504 N
M Bjlilding 78-105 CALLE ESTADO
L� No 14590
Address 78-820 Sonesta Way LA QUINTA, CALIFORNIA 92253. �N4
Owner
Thomas Plouf fe BUILDING: TYPE CONST. • OCC: GRP.
Mailing
Address same
A.P. Number
s
City
Zip
Tel.
La Q;a<lritt
9253
Legal Description
Project Description
PATIO' COVER
` Contractor.
,:
.. a nertBallder
_.
.Address .
City
Zip
Tel.:
State Lic.
City
& Classif. k.
Lic. #
Sq. Ft.
No. No. Dw.
Size 180 •
Stories Units
'
Arch., Engr., b
Designer ; s-
New ❑ Add ❑
Alter ❑ Repair ❑ Demoli-ion❑
Address
� 9
Tel.
^r.+23c.1as•irs, 4+ i �
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City
Zip
State
trM.e.
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S
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. i
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation
9(�(� �$
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
t
PERMIT
AMOUNT
permit to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance also
:' requires the applicant for such permit to lila 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 Any Section 7031.5 by 'any for
Plan Chk. Dep. '
-
+
i� •
.alleged .exemption. violation • of. applicant a permit
. subjects the applicant to a civil penalty of not,more than live hundred dollars. ($500).
Plan Chk. Bal.
Q,
^
f as owner of the property, or my employees with wages as 4heir•sole compensation,,will
Const.
rc , do,the work, and:the - ructure'is not intended•or offered for. (Sec. 7044, Buisness and
,Professions Code: The Contractor's Llcense�Law.does not apply to an owner. of, who
Mech.
• _ buildsor 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
Electrical
'•� ,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.)
Plumbing
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 who builds or Improves thereon, and who contracts for
S,M.1.•
,
�Q
property.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:)
Grading
_
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
r
Date Owner
Infrastructure
�A
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
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Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
!
r.
.Policy No.-- a Company = t. l _. 1 _ -__ ..
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❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
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TOTAL
g 74.45
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CERTIFICATE OF EXEMPTION FROM
REMARKS
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 pert 'rmance of the work for which this permit is, issued, I shall not
r ,,r n-, s n Yrs � + n i.. f.k_•U� R7.
employ any arson in any rl)3nner so as to become subject to the Workers' Compensation '
Laws of California.
L1 ! fi.s i f if fi 1
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate. of Exemption you ,should become '
ZONE:
BY:
subject to the Workers' Compensation provisions o! th`e Labor Code, you'must forthwith
comply with such provisions or this permit shall be deemed revoked. '
Minimum Setback Distances: -
E•
Front Setback from Center Line
Rear Setback from. Rear Prop. Line +
";
CONSTRUCTION LENDING AGENCY
i
Side Street Setback from Center Line
hereby affirm that there is's construction lending agency for the performance of the
work for which, this permit is issued. (Sec: 3097, Civil Code.) -
Side Setback from Property Lyne'
Lender's Name.,
'Lender's
t
{t
Ir
. Address •
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR ' 1
it
_
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.
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
a'
'
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN.
SQ FT ®
GAS (ROUGH)
URINAL
ESTIMATED -CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
TEMP. POLE
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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
a
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[ -[
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SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vic
SEWAGE DISPOSAL
SO.FT.GAR ® 3Yic
HOUSE SEWER
FIRE ZONE ROOFINGl_lN
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
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
FINAL INSP.
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFINGl_lN
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL