11063 (PAT)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 52-880 AVENIDA VILLA. LA QUINTA, CALIFORNIA 92253
THOMAS GRIPTTHS
Mailing
Address SAME
City lZip
OWNER BVILD..R.R
Address
SAME
No. 11063
LDING- TYPE CONST. OCC. GRP..
IA.P. Number
564-3098 Legal Description
Project Description PATIO. COVER LAi'TICR-16' BLOCK
WALL
City
Zip
Tel.:
State Lic.
City
& Classif.
Lic: #
Sq. Ft.No.
140'
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 Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
$ -62 00
reason:-(Sec..7031.5,Business and Professions Code: Any city or .comfy which requires a
s
permit to construct, atter, improve, demolish, or repair any structure, prior to 8s issuance also
requires the applicant for such permit to file a signed slatersnt that he Js icemsed pursuant to
PERMIT
` AMOUNT
the provisionsmr
of the Contractor's License Law, Chapter 9 (co encirg with Section 7000) of.
-
Of0sion 3 of the Business and Professions Code, or Mal. he is exempt therefrom, and the basis
for the Any Section. 7031.5
Plan Chk. Dep.
-
alleged exemption. violation of by arty applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred da0ars (5500)_ '
"
•>Lp
Plan ChkBal
.
- _
Q
r54.00
. 1, as owner of the property, or_my employees with wages as their sole compensation, will$33.
the work, and the structure is not intended or offered for sale: (Sec. 7044, Busness and
.
Const.
Iltl0
- Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or improves thereon and who does such work himself or through his own employees.
Mech..
., provided that such improvements are not intended or offered for sale. 9, however, the building
,
or improvement is sold within one year of completion. the owner -builder wa have the burden
Electrical
of proving that he did not build or Improve for,the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with -licensed contractors to con-
Plumbing
struct the project. (Sec. 7044, Business and Prolessios Code., The Contractor's License Law
..
does not appy builds to an owner of property, who bts or improves thereon, arid. who contracts for
S.M.I.
• VV
• such projects with a contractor(s) licensed pursuant to the Contractors License law.)
'
Grading
❑ lam exempt under Sec. B"'& P.C. for this reason
j e P
Driveway Enc.
+4'3 „t � `
Dat �, - � '"'Owner a-••' e-1 r-�
Infrastructure
99
WORKERS' COMPENSATION DECLARATION
1 'hereby affirm that I have a certificate of consent to self-insure,'or a certificate of
Workers Compensation. Insurance,orr a. certifiedcopy thereof_ (Sec. 3800, Labor Code.)
PolicyCop Company
Copy is filed with the city.. .O Certified copy is hereby furnished.
; hii a+ s. 3 T z `r,ati r",r t -.
� �. � �'� � _ � � <� -• R ,
TOTAL
°
89-.° VCERTIFICATE
t OF
REMARKS
WORKERS' COMPENSATION INSURRAANNCE
(This section need not be completed if the permit is for one hundred dofars ($100) valuation
orless.) -
I certify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in anymanner 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 shadd becorne
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, Cfw7Code.)
Lenders Name
Lenders Address
Thisls 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.
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
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 Permit
Validated by,:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES~
IST FL. SO. FT. ® $
2ND FL SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ic
HOUSE SEWER
FRAMING
FINAL INSP.
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 w PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
firz V-4GROUND
PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
n
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.�.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL