08249 (PAT)P.O. BOX 1504 N o . 0824-9.
Building 78-105 CALLE ESTADO
Address 44-416 • :. 1.4mffffilillill Crest LA QUINTA, CALIFORNIA 92253
Owner
13 n BUILDING:. TYPE CONST.. OCC: GRP.
Mailing ,
Address Sam A.P. Number 604-110-042
City Zips T
. 92 �369639- Legal Description Lo 78
Contractor DiV.fl pa41 C-l�r ject Description Le Qtdit3ta Palms Patio
i€. tf �etQ sleeks iottcl..
Address . - .. ConsUrl ictim
arm Aa sFo
City Zip Tel.:
ii a:' ;;; 92201 347-4186
State.Lic.- City'
& Classif. - Lic. # Sq. Ft. No. No. Dw.
0055 ��� ��; 'Size Stories Units
Arch.; Engr:; i
Designer_ '- , New ❑ Add ❑ Alter ❑ Repair ❑ Dem'olition ❑
Address ' Tel.
City 'r; i ` Zip State
`� • Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 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
IGNATURE - .. d!' rC'✓..': wt'�,V'" v.... r �, -.e'l' DATE
'OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law'for the following Estimated Valuation $3596
reason: (Sec. 7031.5,Business and. Professions Code: Any city or countywhich requires a.
permit .lo construct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant -for such permit to role a signed statement that he is licensed. pursuant to PERMIT 1
the'provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
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 Plan Chk. Dep.,
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). .Plan Chk. Bal.
❑ 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 Const. - ��y
Professions Code: The Contractor's License Law does not apply to an owner of property who.(lti'
builds or improves, thereon and -who does such work himself or through his own employees,.
provided that'such.lmprovements are not intended or offered for sale. If, however, the building Mech.
or improvement is 'sold within one year of completion, the owner -builder will have the burden Electrical -
or proving that he•did not build or improve for the purpose of sale.) 4.-
0 I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
strucl 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 S.M•I. �?
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
❑ I am exempt under Sec. B. & P.C. for this reason 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.)
Po it by No. Company
40M.Copy is filed with the city. ❑ Certified copy is hereby furnished. r
TOTAL ,/V/ • �>< '� .
CERTIFICATE OF EXEMPTION FROM REMARKSfy _ e--
WORKERS' COMPENSATION INSURANCE - '
(This section need not be completed if the permit is for one hundred dollars $100 valuation +"
or less.) '• � .,my„
I certify that in the performance of thg work for which this permit is issued, I shall not
emplany person in any manner so as to become subject to the Workers' Compensation
Lbws ooy f California.. % ,:
Date , r°, -, Ii :.:Owner +1 .-x ... "', ." . _ 11
NOT ICE'TO'A'PPLICANT: If, after makidg tfiis Certificate' -.of -Exemption -you should become -ZONE: BY:
subject to the r'Workers' Compensation provisions of the LaborfCode, .you must forthwith
comply with such provisions or this permit shall be deemed revoked. - Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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 Setback from Property Line
Lender's Name
Lender's Address
This is a'building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
� ��TO
expiration it 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 abovew
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
\ _j v�.x` r:ti. .� -Sz �Yt. .. 'ri, i...'4. 1 t• .. .,�..., .�16 .. � ,I• _.. .•••.r1 :. .. ~ -,t, .+�,,�t :, •.+, a-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® 3/ec
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
OLAR-
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. (/Q
c
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION to Q
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL