15788 (PAT)P.O. BOX 1504
78-'730 W. Harland 78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
`"...... Ronald J. Manna
78-730 T9. Harland Tyr.
La Quinta 92253
itractor Omer Builder
Address
State'Lic.
& Classif. .
Arch.; Engr.,
Designer.
Address
Same as above
City - (Zip (State
Lic. A
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with•Section
710000)t f Division 3 of the Business and Professions Code, and my license is in full force and
SIGNATURE DATE
OWNER•SUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: ,(Sec. 7031.5,Bushmss and Rdesa(ons Code:- Any city or county which requires a
Permit to consfnrct, after, Irwrove„ den ofth, or repair any structure,, prior to Its Issuance also
requires the applicant for such permit to Me -a signed statement Mat: he is licensed pursuant to
Me provisions o/ the Contractors License Lew, Chapter a (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 app/kant for a permit
subjects,the applicant to a civ0 penalty of rpt more than live hundred dollaro (5500).
as owner of the property, or my employees with wages as their sole compensation, will ,
o the:work, and the structure Isnot Intended or offered for sale. (Sec. 7044, Bulsness•and
Professions Code: The Contradw a License Law does not apply to an owner of property who
bulls or Improves thereon and who does such work himself of through his own employees, '
provided that such tmprovwnwft are not Intended or offered, for sale. N however, the building
or improvement Is sold within one year of completion, the owner-buider w11 have the burden
of proving that he did not bulli or improve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and •Prolessions Code: The Contractor's License Lew
does not apply to an_ owner' of property who bulds or Improves thereon, and who contracts for
such pro%actawith a crontractor(s) licensed pursuant to the Contractor's. License Law.)
❑ 1 am exempt under Sec. a..8 P.C.'for this reason
to Owner.
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate.of
Workers 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
d ft
(This . section need not be completeMe permit Is for one hundred dollars ($100) valuation .
or less.) performance -certify that In the perforence of the work for which this permit Is issued, I shall not
employ any ppeieon in.any manner so as to become subject: to the Workers' Compensation
Laws of,Califomla
Bate Winer
NOTICE TO APPLICANT: d, 'after rrmbV ,this Certificate o1Exemption you should become
• subject 10the Workers' Centpensation _ proMsioris of the. Labor Code, you must forthwith
comply with such provisions or this permit stab be dawned 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 (5100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS .PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
This Ie.a building permit when properly filled out; signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
1 car illy that I'have read this application and,state•that the above Information Is correct
I agree 4o comply with all'city'and.county ordinances and state laws. relatlog to building
construction, and hereby authorize representatives .of. this city to enter the above-.
mentloned property for Inspection purposes
Signature of.applicant Date
Mailing. Address
City, State, Zip
No. 15785
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description ( 2) 4f I X
at back sliding glass
OCC: GRP.
61 Patio covers
doors.
Sq. Ft. 54 No.
Size Stories
No. Dw.
Units /
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation $718.00
i
PERMIT
AMOUNT
,Plan .Chk. Dep. .
Plan Chk. Bal.
$16.25
Const.
$25.00
Mech.
Electrical
Plumbing
S.M.I.
$ .50
Grading
Driveway Enc.
Infrastructure
TOTAL
.75
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from CentaFIL' e
Rear Setback from R ne
Side Street Setback nter 'ne
Side Setback fr roperty L
FINAL DA'
Issued by:
Validated by:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEES
IST FL. SO. FT. a $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. a
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CARiP. SO. FT.
OTHER APP:IEOUIP.
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN -
SO. FT. a
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used;as property tax valuation
WATER .SYSTEM
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
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.
SO. FT. a c
BATH TUB
SPARK ARRESTOR
SO.iFT..a•c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID a 1 V. c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR a 3Ac
HOUSE .SEWER
GASPIPING
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 8 AIR GOND. 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
iDUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP:IEOUIP.
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 11
CERT. OCC.
FENCE. FINAL -
INSPECTOR'S SIGNATURESIINITIALS
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