15075 (PAT)r ,
P.O. BOX 1504
Building' 78-495 CALLE TAMPICO
Address 78-790 Irwin Circle LA QUINTA, CALIFORNIA 92253
Owner .,,Jack Tapelshay
Mailing
Address a�7aj'd'1
City Zip Tel.
Zia Quinta, CA 9 253 1
Apollo.S'C6nstruCtionz
Address
$.O. Box 977
CLa Qu1F�ti.a , CA Zip �`� �
State Lic. -8 619680
& Classif..
Des Arc�g ergr, Robert" Mkfman
'-771-3145
City 22.31
Lic. #
BUILDING: TYPE CONST
No. 15075
OCC: GRP.
A.P. Number
Legal Description
Project Description Reek Over Patio
Sq. Ft. 228 No.
Size • Stories
New ❑ Add ❑ Alter ❑'
No. Dw.
Units
Repair ❑
Demolition ❑
��
A ddfYeSKIfar'* Dr.
Te15S6r-296 7
.
City
Rancho Mirage
Zip
CA 92274 -.
State
Lic. #
{ 1 LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensedturider provisions of Chapter 9 (commencing with Section
j000) of Division 3 of the Business aynrd Professions Code, and my license is in full force and -
kffect.' �. ..Iir4^.•:.n + _ t
i$jGNATURE - rt•"�1"� s• DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: .(Sec., 7031.5,Bustness and Professions Code: .Any city or county which requires a -
permit to construct, after, 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 thathe 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 thework, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contmctor's License Law does not apply to an owner of property who
or bnproves thereon and who does such work himself or through his own employees,
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 -bulkier will have, the burdenElectrical
of proving that he did not build or inprove for the purpose of sale.)
Estimated Valuation gS I�
$3. 33.00
- -
PERMIT AMOUNT '
- -
Plan Chk. Dep. '
Plan Chk. Bal. 40 95
�� l,�•
Const.builds
Mech.provided
b
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 l to an owner o/propertywho builds or improves thereon, and who contracts for
aPPY P
- such projects with a contractors) flcensed pursuant to the Contractor's License Lew.)
O I am exempt under Sec. B. & P.C. for this reason
S.M.I. !!��
J • 3V
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.)
Policy No. Company
py is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL 104.25
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
REMARKS
(This section need not be completed if the -permit is • for one hundred dollars (8100) valuation
or less.) (1 f z y X
I certify that in the performance of thip work,for which this permfN1 2ssued,•I shall not
employ any parson in anytmanne`r so`as to becombject,lo IN ars' Compensation
Laws of California
Date Owner**
. NOTICE TO APPLICANT: ft, after 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
Rear Setback from Rear Pfop. Line
Side Street Setback fro nt Line
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
' This is a buildingFINAL
permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
Side, Setback from Pro • Line
% a
DATE IN ECT_O�
,p
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: Date_"fie ; t
Validated by: 11 ,^Q GJ _
Signature of applicant -Date-
ateMailing Address
Mailing
Validation:
\ 7 f
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK Fp>
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING f
t
WALL SD. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax -valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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
ISHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Ya c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
MESH
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 l
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCTWORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
l
t FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL
j