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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.