003474 (PAT)CV
P.O. BOX 1504 Nu."��
Building 78-105 CALLE ESTADO
Address 78-730 Avenida LS Fonda LA QUINTA, CALIFORNIA 92253
Owner
Mailing _
BUILDING: TYPE CONST. • I OCC: GRP.
Address
A.P. Number
769-436-010
City
Zip
Tel. _
La Ouinta
_ 92253
Legal Description
Project Description
Patio Cover
Contractor
• Y
Address
City'
Zip
Tel.
State Lic.
City
& Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
• Arch., Engr.,
New ❑ _ Add ❑
Alter ❑� Repair ❑ Demolition ❑
Designer
Address
Tel.
City
State
JZip
-
L•ic.#
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
' I hereby affirm that I am exempt from the Contractor's License law for the following9
reason: (Sec. 7031.5,Business and Professions Code: Any city or county 'Which requires a
permli to construct, alter, 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 that. he 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 or not more than five hundred dollars ($500). "
- ❑ 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
. Professions Code: The Contractor's License Law- does not apply to an owner of property who,
builds or 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.
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 or sale.)
Estimated'Valuation
h
l 0
0
PERMIT
_ AMOUNT
Plan Chk. D'ep.
'
Plan Chk. Bal..
A
A 44.52
Const.
w
Mech.'
Electrical
'
Plumbing `•
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
strucl the project. (Sec.,. 7044, Business and Professions Code: The Contractor's License Law
, S. M.1.
.
r
does not apply to an owner of property who builds or improves 'thereon, and who contracts for
• 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 ^!+�'Y •' 'Owner {- /+�- r ' --`'
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
❑ Copy is filed with the city. ,. O Certified copy is hereby furnished.
TOTAL
„
_
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
'
(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
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
r -mac rt++ s +rMIr3 r n_ r1r)_t+-f A
j?1 CA j" i j iUTA1. I t
Date' Owner
NOTICE TO APPLICANT: If, after making this Certificate or 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
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY .
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.)
Lender's Name
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Address
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 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 sof this city to enter the above-
mentioned property for inspection purposes.
FINAL DATE
Issued by: -
Validated by:
INSPECTOR
s f
Date 10 /.28 €Permit-
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
HARD COPY
i. CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING F r
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. @
GAR. SQ. FT. ®
.CAR P. Q. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $.
UNITS
MOBILEHOME SVC.
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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP.IEQUIP.
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. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
G
SO.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
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.IEQUIP.
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
G
DEC
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
-
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIG NATURESIINITIALS'
GARDEN WALL FINAL