003473 (SFD)Building
Mailing
Address
7&1 5 CA BOX E ESTADO
46-400 DUL® PalMS Rd. LA QUINTA, CALIFORNIA 92253
City Zip Tel.
La-ui a 92253
Contractor
P. Cps Box 355
Zip • - Tel:
State Lic.
& Classif. 4A321
Arch., Engr.,
Designer
Address
Lic. # +
lyd
Tel.
City Zip State
Lic: #
LICENSED CONTRACTOR'S DECLARATION -
1 herebyaffirm,that I'am licensed.under proviaiorls of Chapter 9 (commencing with Section
7000)'of Division 3 of'thr Business end P fessio Coda, and my license is in full force and
' �1 I i-' A� t -1
ee fact. `,i'- V . ? t` ll } it 3( I `�
SIGNATIIiiE r -/ ' et ` �•'Y , DATE
OWNER -BUILDER DECLARATION
1 hereby'affirm that l am exempt. from the Contractors License Law for the following
reason: (Sec. 7031.5,Business. and Professions Code: Any city or county whish, requires a
permit to construct, alter. Improve,. demolish, or repair any structure; prior to tis 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 appik:ant • for a pemur
subjects the apprcant to a civil penalty otnot more than five hundred dollars ($500). -
❑ I, as owner of the property, or my employees'with wages.as their soie.compensation, will
do the work, and the structure is not Intended or offered for sale.•(Sec. 7044, Buianess 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 safe. If, however, the building
or improvement is sold within one year of completion, the owner•builder' wi0 have the burden
of proving that he dM not build or improve for the puipose of sale.) - -
❑ 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)- icensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date ' Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have's certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3900, 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 U 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 pperson to any manner so as to become subject the Workers' Compensation
Laws ofCalifornia.
Date Owner _
,NOTICE TO APPLICANT: lf, 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'ls a construction lending agency for the performance of the
work for which this permit Is4ssued., (Sec. 3097, Chill Code.) -
Lenders Name
Lenders Address
This Is a building permitwhen properly filled out, signed andWalidated, and,is subject.to
expiration if work thereunder is suspended for 180 days:
I certify that IL 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, Zlp
HARD COP
No• .003473
BUILDING: TYPE -CONST. OCC. GRP.,
A.P. NumberM l�tiiilE: P�`33zg - Paxk
i .r(�.?3l- ILIi `e —e
Legal Description
Project Description www 1- 01%1 Ism d►amt= ` h6,P�;4CE3aA
patio cover .
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition _❑
Estimated Valuation
$700.00
PERMIT AMOUNT
Plan•Chk. Dep:
Plan Chk.. Bal.
const.
$213.00
Mech.
Electrical
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL S2213a 00
REMARKS
:a:lr_3✓`.,.`". '!� "`-^si is-:
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 10,% 7 Mrmit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT. ®
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT. 0
DRINKING FOUNTAIN
SO. FT ®
HEATING (FINAL)
URINAL
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
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ -Plus-x$-=$
LAUNDRYTRAY
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. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT..RESID 11/4 c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3'.c
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
GAR. FIREWALL
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 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
Ci
REMARKS:
VENTILATION
FIRE ZONE ROOFING ,
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
"
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS,
GARDEN WALL FINAL