10848 (PAT)44
P.O. BOX 1504 // No. 10848
Building45� �� 3�'Bert COtlxt 78-105 CALLE ESTADO /
Address 5 LA QUINTA, CALIFORNIA 92253
Owner
Z(
S.R.D. Dev.
01 illlklf'- -rV0l= CONST OCC' GRP
Mailing
Address 45--275 Desert _agle. Ct
City Zip Tei.
ra Quinta 32253 1 345-1216
Contractor
Oam- e
Address
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
P. Number
Description
Description
Patio Cover
%,ILy ,~
Lic. # Sq. Ft. 2,20 No. No. Dw.
` Size Stories Units
City Zip . , State
LICENSED
9 (commencing with Section
my license isJn full force and
JllirvglUMt' .�/ � � - A1C
DOWNER -BUILDER DECLARATION
I hereby affirm that l am -exempt from theContractor's License Law for the following
reason: (Sec. 7031.5,6usiness 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'sLicense 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 file hundred dollars.($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, arid 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. g, however, the building
or improvement is sold within one year of completion, the owner-bur7der will have the burden
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-
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 contractor(s) licensed 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
. 0 -copy is filed with the city. `0 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: ft, after making this Certfficate 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. -
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
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 -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
New ❑ Add' ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation 9'.882
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 35.10
Const. 54.00
Mech.
Electrical
Plumbing
S.M.I. .30
Grading
Driveway Enc.
Infrastructure
TOTAL 89.40
REMARKS
. , `-"`•��e;..:, f ��l^�4`f' �IiJ;ft`°�L_. f� . �.. #•3�i. �t7
ZONE: BY:
Minimum Setback Distances:
Front Setback.from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permi
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. S0. FT.
HEATING (ROUGH)
POR. S0. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. S0. FT. ®
POWER OUTLET
ROOF DRAINS
ROCK STORAGE
FOUND. REINF.
DRAINAGE PIPING
CAR P. S0. FT. ®
WALL S0. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
S0. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER HEATER
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
KITCHEN SINK
ABSORPTION SYSTEM EA B.T.U.
JITEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM ORCED AVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U. v
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
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 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�,/�
p L //7J/
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL