13443 (PAT)Building
Address 78--640 Forbes Circle
Owner Patric: Prase
Mailing Sam
Address
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.
La Oninta, CA 12253
Contractor
Owner%ElUi i der
Address
Zip
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
City( Zip I
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
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which, requires a
permit to construct, alter, 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
subJJ,,•��cts the applicant to a civil penalty of not more than five hundred dollars ($500). -
&u as owner of the property, or my employees with wages as their sole compensation, will
O he work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Pro essions 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,
i 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 of sale.)
0 I, 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) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
ate 2/ rl- Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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. ❑ 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 thg work for which this permit is issued, I shall not
employ any person in any many eP so as to become subject to the Workers' Compensation
Laws of,t l5p ia
a
1,� Date ' 1 `
Owner r
NOTICE TO APPLICANT: If, after making this' Certificate 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 sof this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 13443
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
OCC: GRP.-
Patio Cover
Sq. Ft. 360
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$4,73 8.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
• ��
Const.
•
Mech.
Electrical
Plumbing
S.M.I.
t%
Grading
Driveway Enc.
Infrastructure
TOTAL
JL I ` •J U
REMARKS
ZONE:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Cuter Line
Side Setback from Pr6ol erty Li e.
FINAL DATE INSPECTOR
Issued by:
Validated
Validation
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM '3
2ND FL. SO. FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. I SQ. FT.
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus x$
_$
URINAL
SQ. FT. ®
FINAL INSP.
FRAMING 1
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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. a 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/ec
HOUSE SEWER
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./EQUIP.
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 1
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING (�
FINAL INSPECTION `
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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overall Iecgth
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tooting 12"
Below Grade
Cootiouous Ledger
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Mail Liter to 11otk1ng
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6-3
6-4
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9-0
110-6
B-8
6-5
6-9
5-2
2 x5
12" c. c.116-3
17-10
17-5
3-0
13-7
10-0
16-
15-1
11-3
11-9
i
24"
13-3
12-4
9-2
9-7
7-1
32-
10-10
9-11
7-6
7-0
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2x8
16• o.c.
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21-5
19-10114-10,
6-3
12-1
12-8
9-4
32-
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13-0
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7-0
T-4iT 4 4a 09WO
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1=.1
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Asgle -j
I,.� Ilo eorresiie.
6"
A11 Crade
s.�. •�,
L
tbofinq Mote
a. Mood snakes 4/12 pitch (3/12 min. pitch t=•'.h 30t
felt tr+de.rlay) Class A
Mbcd. ca:prositior. s •=;Ies 4/12 pitch- 13/12 min.
pitch with 151 felt trtdc lay► . Class A
c. cult up rolled roof slope to drain.
d. §rock rwf a n -j ...-.
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dougMo,1
dineSilt w
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6x10..... 18' 1.6,10 14,
tbofinq Mote
a. Mood snakes 4/12 pitch (3/12 min. pitch t=•'.h 30t
felt tr+de.rlay) Class A
Mbcd. ca:prositior. s •=;Ies 4/12 pitch- 13/12 min.
pitch with 151 felt trtdc lay► . Class A
c. cult up rolled roof slope to drain.
d. §rock rwf a n -j ...-.
S
7WIM PNITG W R
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