15562 (BLCK)eJ
Building
Address 78-720 La Fonda
OwNer S Vh Etin er
4
P.O. BOX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
Mailing
Address Same
City Zip ITel-
La
Quinta, CA 1 92253
Contractor
Pate Coat Engireerirg Inc.
"WIT00 Ave. 42
city Zi Tel.:
Indio, CA 220 5-3950
State Lia City
& Classif..' A 609632 Lic. #
Arch., Engr.,
Designer .
Address Tel.
City ( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION ..
I hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section
1000) of Division 3 of the Business and Professions Code, and my license is in full force and,
,� ffact: C +;_ .�i�d k e. Pr �, ,t�' ` iF
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
- reason: (Sec. 7031.5,ausiness 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 file 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 of not more than rive hundred dollars ($500). .
O 1,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 knprove for the purpose of sale.)
❑ 1, 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 apply to an owner of property who builds or improves thereon, and who contracts for
such projects with -a contractors) #fcensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under -Sec. B. & P.C. for this reason`
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Cor
r1pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
'1196loy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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 the 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
Date Owner
NOTICE TO APPLICANT. d, after making this Certificate of 'Exemption- you should become
subject to the Workers' Compensation provisions of the tabor Code, 'you must forthwith
comply with suchprovisions or this permit shall be deemed revoked. -•
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
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,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, ,INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when properly filled out, signed and validated, and is subject to.
expiration it work thereunder is suspended for 160 days. r
I car lfy that I have read this -application and slate that the above information is correct..
1 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.
Signature of applicant Date
Mailing. Address
City, State, Zip
No. 15562
BUILDING: TYPE CONST. - OCC: GRP.
Number
Legal Description
Project Description 75 1. f • of 51 high garden
'olock wall.
Electric
and plumbing for
ond.
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition=❑
Estimated Valuation
I
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
45.00
.Mech.
Electricalrj
Plumbing
15.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
00
REMARKS
ZONE: BY: 11`6:1 t ; kL-
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line t
Side Street Setback from Center Linej` '
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by:- Date° Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. p $
UNITS
.SLAB GRADE
2ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM R
POR. SO. FT. p
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. p
POWER OUTLET
ROOF DRAINS j
CAR P. I SO. FT. p
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT. p.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO. FT. p
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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
+
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, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. p c
BATH TUB'
SO. FT. p c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID p 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR p V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE " IPL.CK.FEE
CONST. FEE ELECT. FEE
SMIFEE 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 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
�v ��
REMARKS:
VENTILATION'
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
- --
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
v
Ak�p
PGOEAREA TO BE ENCLOSED BY
MINIMUM 5 FT. HIGH FENCE.
ALL GATES TO 81 "F -CLOSING
AND fid, r-
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t
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