14621 (PAT)C&tyl
1
P:O. BOX 1504 N o . 1462
Building 78-495 CALLE TAMPICO
Address . 44 -*'-960 Tortola Circle. LA QUINTA, CALIFORNIA 92253
Owner Robert & Kathleen DuPaf1L
Mailing
Address Sable
CityZip Tel.
La.. Quinti,.. CA 92253 - (619) 360-y2798
Contractor
Address_
. lZip
State Lic.
& Classif. .
Arch:; Engr.,
Designer
Address
City
Lic. #
Tel.
BUILDING: TYPE CONST. i OCC: GRP.
A.P. Number
Legal Description
Project Description. Patio' Cover
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ - Alter ❑ Repair❑: - Demolition ❑
I hereby affirm that I have a certificate of .consent to self•msure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) ..
Policy No. Company.
❑ Copy is filed with the city: ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred • dollars ($100) valuation -
orless.)
I certify that in the performance of the work for which this permit is issued, I -shall not.
employ any person in any manner sous to become subject to'the_Workers"Compensation
Laws of California-
Date-Owner
aliforniaDateOwner
TOTAL 134.18
REMARKS
NOTICE TO APPLICANT: !f, after making this Certificate- o/ Exempthn you should become'ZONE:'BY:
°�`N•
subject io the Workers' Compensation provisions of the- Labor Code, you must forthwith
City
Zip
State
_
Lic..#
Front Setback from Center Line—9
LICENSED CONTRACTOR'S DECLARATION
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL", AND,
I hereby affirm that I am licensed under provisions of Chapter W(commencing with -Section '
7000) of Division 3 of the Business and Professions Code, and -my license is in full force and
Side Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO'CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE"
effec• - - • .
t.
'. HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE•COST OF COMPENSATION, '
SIGNATURE DATE
Side Setback from Property Line
DAMAGES AS PROVIDED' FOR -IN SECTION 3706 OF THE. LABOR CODE, INTEREST, AND
OWNER -BUILDER DECLARATION
I hereby I from following
_
Estimated*f
j a�
ATTORNEY'S FEES.''-
affirm that am exempt the Contractors License Law.for the
.,reason: (Sec. 7031.5,Business.and Professions Code:.Any city•or county which requires a
.Valuation
I.�
..
permit to construct, after, improve, demolish, or.repair any structure, prior to its: issuance also'
_.
expiration if work thereunder is suspended for 180 days:
requires the applicant for such permit.to file a signed'statement that'he is licensed- pursuant to
PERMIT - -
AMOUNT '
. the provisions of the Contractor's License Law, Chapter 9 (commencing with' Section '7000).of
"the
Date Permit
`
Dlvlslon 3 of Business and Professlons Code, or that. he is exempt therefrom, and the basis-
for the Any Section 7031.5 by 'any for '
Plan •Chk. Dep. -
construction, and hereby authorize representatives of. this city to enter the above-.
alleged exemption. violation. of applicant a permit .
subjects the applicant to a civil penalty ofnot more than fide hundred dollars ($500). • . '. a •
Plan Chk. Bal.
�� 63
0 I, as owner of the property, or my employees with wages as_their sole compensation, will
„ .
do the work, and the structure isnot intended or offered for sale. (Sec: 7044, Buisness and' r
Const,
O
t7"0
Professions. Code:- The Contractor's License Law does not. apply. to, an. owner ofproperty who
p
builds or improves thereon and who. does such work himself or through his own employees,
-'Mech.
provided that such improvements are not Intended or offered for sale. If,, however, the building
'
or Improvement is sold within one year or completion, the owner -builder will have the burden
Electrical '
'
of proving that he did not build or Improve for the purpose of sale.) ..
O'1, as owner of the property, am exclusively contracting with licensed contractors to con-
r Plumbing
struct the project. (Sec. 7044, Business and .Professions Code: The Contractor's License Law
.
does not apply to an, owner of propertywhobuilds or. improves thereon, and who contracts -for -
such projects with'a contractors) #tensed pursuant to the Contractor's License Law.) . -
S.M.I.-
�. 5.3
-
Grading
• ❑ I am exempt under Sec. B. & P.C: for this reason
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of .consent to self•msure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) ..
Policy No. Company.
❑ Copy is filed with the city: ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred • dollars ($100) valuation -
orless.)
I certify that in the performance of the work for which this permit is issued, I -shall not.
employ any person in any manner sous to become subject to'the_Workers"Compensation
Laws of California-
Date-Owner
aliforniaDateOwner
TOTAL 134.18
REMARKS
NOTICE TO APPLICANT: !f, after making this Certificate- o/ Exempthn you should become'ZONE:'BY:
°�`N•
subject io the Workers' Compensation provisions of the- Labor Code, you must forthwith
Distances:
comply with such provisions or this permit shall be deemed revoked. -
Miriimum.Se4tiack " -
Front Setback from Center Line—9
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL", AND,
-
Side Street Setback from Center Line
SHALL SUBJECT AN EMPLOYER TO'CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE"
'. HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE•COST OF COMPENSATION, '
Side Setback from Property Line
DAMAGES AS PROVIDED' FOR -IN SECTION 3706 OF THE. LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.''-
FINAL DATE"
INSPECTOR
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.l 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING. FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE •
YARD SPKLR SYSTEM
2ND FL. S0. FT.
HEATING (ROUGH)
STORAGE TANK -
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. p
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT.
GAS (FINAL)
WALL SO. FT.
DRINKING FOUNTAIN
GROUT
URINAL
SO. FT. ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
CU. yd.
$ plus x$-=$-
$=$ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.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
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./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
CU. yd.
$ plus x$-=$-
$=$ROOFING
LUMBER GR.
FINAL INSP.
FRAMING
)
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION S
CERT. OCC.
FENCE FINAL -
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL