14282 (PAT)P.O. BOX 1504 N O . !
Building 78-720 La Palma 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner
Dan & Fury Winter
Mailing BUILDING: TYPE.CONST. OCC. GRP.
Address Same
A.P. Number
City Zip Tel. -
La Quinta, CAI 92253 Legal Description
Contractor Project Description Patio Cover
James Dalton Gen. Cont.
Address
30-255 Ave. Uel Yermo
'6yathedral Citt ;p C X 234 Tel. 7700260
State Lic. City 1
& Classif. A 630403 Lic. # Sq. Ft. 520 No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel-
City Zip State
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. -
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuatios(51916.00
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
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
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). j s V
i, as owner of the property, or my employees with wages as their sole compensation, will - Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. •
Professions Code: The Contractor's License Law does not apply to an owner of probeny who
builds or improves thereon and who does such work himself or through his own e,nployees, Mech.
provided 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 -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- Plumbing
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 S. M.
• n
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
I am exempt under Sec. B. 8 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.) r.
Policy No.' I Company
Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL •
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 performance of thg work for which this permit is issued, I shall not r—
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
Front Setback from Cen ne
Rear Setback from Re r p. Lin
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback f Ante
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 pert
DAMAGES AS PROVIDED FOR IN SECTION 3706. OF THE LABOR CODE, INTEREST, AND,rr(J O
ATTORNEY'S FEES. _
This is a buildingFINAL DATE I CT
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. Issued by: L - Date Permit �i
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
j
' Mailing Address Validation:
City, State. Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. SO. FT.
WALL SO. FT. ®
SO. FT.®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC. '
I POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. (a c
BATH TUB
SO. FT. (& c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® iIA c
SEWAGE DISPOSAL
SO.FT.GAR ® i.c
HOUSE SEWER
REMARKS:
VENTILATION
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 8 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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
t' 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
CERT. OCC.
FENCE FINAL
1 UM -D WUNA IV KLUINI I IALJ
GARDEN WALL FINAL