11625 (PAT)4
P.O. BOX 1504 N o . 11625
Building 78-105 CALLE ESTADO
Address 5unli (, rptntl 'bra rP_ LA QUINTA, CALIFORNIA 92253
Owner
William E. Elliott BUILDING: TYPE CONST. - OCC. GRP. -
Address 50205 Grand Traverse
City Zip Tel.
La Quinta, CA 92253
Contractor
Owner/Builder
Address
Tela
State Lic.I City
& Classif. Lic. #
Arcn., tngr.,
Designer
Address Tel.
CityI 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,Business 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
subjects the applicant to a civil penalty of 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 of sale.) -
O 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason t
Date/,r/ 4/74Owner ;✓/
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
O 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 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: 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
Ihereby 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
P. Number
Description
Project Description Outdoor oatio cover
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:
Validati
Sq. Ft.
Size 3.44
No.
Stories Z
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$1,915.20
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
• d�
Const.
45.00
Mech.
Electrical
Plumbing
S.M.I.
• 14
Grading
Driveway Enc.
Infrastructure
74.39
TOTAL
REMARKS
�t•,.t
., 11�
i" ttr�,,,
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:
Validati
CONSTRUCTION ESTIMATE '
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. ®
GROUT
WATER HEATER
WALL SQ. FT.
FINAL INSP.
DRINKING FOUNTAIN.
SQ FT ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
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
FIRE ZONE ROOFING
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.
SQ. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U:
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4C
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.
RAMING —
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 SIGNATURES/INITIALS.
GARDEN WALL FINAL
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CITY OF LA QUINTA
Eff J)°.Nu & SAFETY DEPARTMENT
CONDITIONALLY
AC EP T FEU FFR G0 a; �RUCT10N
TO INS T ALLATiON AS HER
AN6ECAPPLIdABLE CODES
DATE 1113 --- BY d(m"� L
1:1 E C— 2 1 9= 1 r•1 A F- u I S r•1 1;4 t -a 1;4 G. E r•1 E h4 T R- 0 2
'� . - • A.�CHz'�C�OeZAI, AP9ROVe�t, APPLICATION
.S'S DA&E:.��.Z'y
PH0-4 •
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MQDZs IGriTI4;1 R:QU a iGO: C1rq Sen --4.1 N L2 &e &j C2
Arch_; tectu,al Cor:-►ittee:
You a=e hereby advised that the following work is proposed and acproval is re-
q•:ested.Attached are dravi.ngs- of the work to be done and types of ma=e.ials to
be used a,e indicated on the dra —nqs. We understand that buildi-S pe =ics
fvr hcr..e i^_ rove -e .ts are reyui,ed by the city of is Quinta and that the
cCst of. the pe; -its and the re.sro,sibility of abcaining permits and subsequent
i..^.specti,on will be borne by tate apolicznt.
We acknowledge that all approved changes in the original design will be at our
expense; that any damage to or relocation of existing sprinxler systems, Under-
g_ou-d utilities, building structure and exterior landscaoing or other damage
resulting from the construction of these permitted i�zmpcoven, ents shall be at our
expense; and that the maintenance of the permitted i.m?rove len6ts Shall be at
our expense.
We also ack::owled a that construction of the requested and approved modifica-
tions must begin within thirty (30) days of our receipt of written approval,
and that said approved modification must be completed within sixty (60) days
of receipt of writtea approval. Failure to comply with these or any of the -
above specifications Will result in the nullification of this document and
subsecuen- approval thereof.
0WN. ZR:��/, �.�,.� r..� e. S,_,_s ot-r SIGNATURE:�11L." in M"► . ,�
please print
•*::wt:*.�:•:*ft#:ss.rt�r**►re*+ri:r**tirsti•rr*rpt,►rsr•,►�*rr�♦rr:trr,e,►riss�*
The above reC4ested has been reviewed by the Architectural Coxndttee and
has beer:
ApPQOV=D REJECTED BE:D $SuoING INVa,5TIGATION
Ca LIAXNTS :
bate reviewed:
SEIM TO:
MARQOIS HANAGF-MM.NT GROUP,
35-975 DATE PA -1i DR_ # 200
CAT=- RAL CITY, CA 92234
(Board Member) --
y 4 �
3E. r•1AF'QU I S r•1 A N A G E r1 E f4 T- P_ 0 1
AP.CH-117CTpRAj, APPR.OVAZ, APPLICATION
[T` T1oSS :�'�d S=11�-�✓tom ,S t`DATE -- �{ —
Y'iAILTUG �ADpfLSS : Fr30Nc:
1 4
mob TFICATION \R=QiIr-STED
ArCh:itectural C=m.tttee;
Your are hereby advised that the following work is proposed and approval is re-
que.sted.Actached are drawings of the work to be done and types of materials to
be,l'used are indicated on the drawings. We understand that building permits
fo.:. home improver e::tsare required by the City oL La Quinta and that thecost of the pe,�i is an the respo �sz.bility of vbtaininq per -nits and subsequent
inspe;t_on will be borne by the applicant.
i
We `3C'.{'t0'.+led'ge that all a;-ozoved c1hanges in the original design will be at our
exp nse; th4?t any dem2ge to or relocation of existing sprinkler systems, under-
ground utilities, building structure and exterior landscaping ot- other damaga
resUlting f rom the construction OF these per,-,iitted inorovements shall be et Our
eX?e.jse; and that the maintenance of the pe,-,-, tied jrIP- Cots shall be a
- ov_ne t
our expense-
We
xpense_
We also acXnowledge that construction of the requested and approved modifica-
tions must begin within thirty (30) days of our receipt of written approval,
and that said aporoved modification must be completedwithin sixty (60) days
of'receipt of Writtea approval. Failure to comply with these or any of the
abo"e specifications will result in the nullification of this document and
subsequent approval thereof.
0WNER:+./`/1�_�tA►�,�� �. F-7��tcar`7 SIG�ir�.TUR£:1� �r �Cl_1�1f�Yll
(please print)
*'+*tilr�tfifi*tf!**!#*f*ftt!llftffi#11:t;►ltff*fitfitlR#iiiftf#!*!R#tfift***AR1hAt►R
The above requested has been reviewed by the Architectural Committee and
has bee.i:
APPROVED REJECTED 8'.rD PENDING INVESTIGATION'
o
C0Y-1tc.SITS :
Date reviewed :�f 4�
f LXRQOr:�' Mf1NAGIE!.`O~NT GROUP,
," 35--975 DATE FAL.,*[ DR. # 200
► CA'I'fDRAL CXTY, CA 92234
J
APPROVE
a_d Mem
(Po.ard Member)
E4
—DTM,!_�I& -rTLEKb- P
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C 0 H D IT 7 -
EU FO -F! C01*��%;o �,RtUYCTZIONI
"TTO li "ST -A" li-ATiON N� Kri
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AND ALL APPUUEiZ---__.
DATE i itBY
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EU FO -F! C01*��%;o �,RtUYCTZIONI
"TTO li "ST -A" li-ATiON N� Kri
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AND ALL APPUUEiZ---__.
DATE i itBY
L-J
CITY OF LA QUINTA
&SAFETY DEPARTMENT
Im'! TO INS
AND ALL APPUGAGLE'Cli'�
,DES
DATE BY