14728 (PAT)•No. 1,4728
P.O. BOX 1504
Building 78-795 Grand Traverse 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner Teff DIP-- ma o
Mailing BUILDING: TYPE CONST.• OCC. GRP,
Address Same-
A.P. Number
City Zip Tel.
P .L,a Qui'Y ta, CA.. 92253 Legal Description
tContractor Project Description Patio
Ae.. ,
Ydd.b.ss BOX 11.167
CityZip Tel.:
Palm desert, C] 92255 347-8521
State Lic. City
& Classif.Lic. #
B 5414�3'4 2212'. Sq. Ft. No. No. Dvlr.
Arch., Engr.,
Size 44.5 Stories Units
Designer . New ❑ Add ❑ Alter ❑ . Repair ❑ Demolition ❑
Address _ Tel. ;
City I 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
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,Buslness and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish, or 'repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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
f-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). • - .
❑.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
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.)
Po1ic
No. .Company
WCopy is filed with the -city. O 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 provistons 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 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 tobuilding
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
Estimated Valuation S ,r 91 g •(j
PERMIT
AMOUNT
Plan Chk. Dep:
Plan Chk. Bal.
52.65
Const.
81.01D
Mech.
Electrical
Plumbing .
-r--134.24
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
-r--134.24
REMARKS
ZONE: BY:
Minimum Setback Distances: ,
Front Setback from Center Line
— RearSetback from Rear Prop. Line
Sid treet Setback from Center Line '
SSetback from Property Line
'f u Side
FINAL AES I �I INSPECTOR
Issued by: I Date Permit
.13
V lidated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW 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. SO. FT. ®
GAS (ROUGH)
METER LOOP
GAR. SO. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
VENTILATION
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, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
LATHING
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID CFD 1 Va 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---j 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
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
PLAN CHECK CORRECTIONS
Date:
Job Address: 7 $-7�S 4�b L"AVM�4L
Contractor:� II J P-LPS 5 1�2 LD <Z�,
Plan checked by: ku
1-7 l
601VvENT iotiAL, ROOF GU 17 -Lt Ste=
atuticr
y t:-:7 u,�;7 Gra- ► CA -b,
rl � L16 F PLA -Ws ,
r,�
'4
t
M
REQUEST FOR ARCHITECTURAL APPROVAL
Homeowner MQ� mes -Ten Qg- MAlp
Address 78-746 Cp2,a,.,b `rQo,jeese-AA C2 Ll I ""r'& Lot No.
Description of Improvement ;%pT,y fLooF
Items Attached:
Plot Plan Rendering Cross Section
ARCHITECTURAL CONTROL COMMITTEE
roved Disapproved
Conditions of Approval/or Reason for Disapproval
& tFM
Date Signature
Architectural ntrol Committee Chairman
BOARD OF DIRECTORS' APPEAL
(Request the Architectural Control Committee to place you on the Agenda of the
next Board of Directors Meeting)
Approved Disapproved
Reason for Approval or Disapproval
Date Signature
President
This approval does not relieve applicant from obtaining the necessary building
permits from the governmental agencies involved.
This request should be submitted in triplicate. An approved copy will be
returned to the applicant, one copy will be retained by the Architectural
Committee, and one copy filed with the Board of Directors.