08073 (PAT)-tit
1- r P.O. BOX 1504 No. E 08073,
Building 78-105 CALLE ESTADO
Address 79-9114A LA QUINTA, CALIFORNIA 92253 -
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Mailing'BUILDING: TYPE CONST. OCC: GRP.
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Rax, A.P. Number Da�'s+4a
CityZip Tel. k
Legal DescriptionLa QmintA, 4"r%3- Afid-AsAn
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Contractor Y Project Description Patio CV4.
'Address
City Zip Tel..
+, a
-State Lic. :_ •'. City,
- & Classif. t Lic. # • Sq. Ft. No. No. Dw.
-Size Stories Units
-Arch., Engr.,
Designer .; New ❑ Add ❑ Alter ❑ Repair ❑ Demolition.❑
Address . Tel : rA `.
' City Zip State
Lic. #
S j 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 Estimated Valuation
I hereby affirm that I.am exempt from the Contractor's License Law for the following�'� .
reason: (Sec.. 7031.5,Business andProfessions Code: Any city or county which requires a
permit to construct, alter;:improve,'dernolish, or repair any structure, prior to its issuance also - -
requires the applicant forsuch permit to lila a signed statement that he Is licensed pursuant to., ,PERMIT
AMOUNT
the provisionsof the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/ _
Division 3 of, the -Business 'and .Professions -Code, or that. he is exempt therefrom, and the basis
11for.the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five 'hundred dollars x($500). Plan Chk. B8_L" w, a`
❑ 1 ,,as_owner of the property, or my employees with wages as their sole compensation, will r'.
'do the work, and.the'structure is not intended oroffered for sale. .(Sec. 7044, Buisness and. j" va /�
Professions Code: The `Contractor's License. Law does not..apply 7o' an owner of property who Const. ` �� F. , 45s V0
builds or impro4es-.thereonand who does. such work himself or through his own employees,
provided that' such. Improvements are not intended -or offered for sale. I/, however, the building Mech.
or improvement is soldwithinone year of completion, the owner -builder will have the. burden Electrical
of proving that he did -not build or improve for the purpose of sale.)
O I, as owner oG
the property, am exclusively contracting with licensed contractors to con- Plumbing
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 S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date f lrtt'.rs= owner Infrastructure
r - :: •ar. - �.
WORKERS' COMPENSATION DECLARATION {
I herebi :affirm that t 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.
. .. ' ' TOTAL 45:14
CERTIFICATE OF EXEMPTION FROM REMARKS '
WORKERS' COMPENSATION INSURANCE "
(This section need not be completed if the permit -is /or one hundred dollars ($100)valuation - yF1;.65y:y'ti yy$.- ,�}1`1igi:r1- y 114
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1 1 .tint,. ,5 '� 8 41 4
certify that in the performance of the work'.for which this permit is issued, l shall not
employ any person in any manner so as to become subject to the Workers'. Compensation
Laws of California. ',�•
bate 'bwoer
NOTICE TO -APPLICANT:If,' after making this Certificate o/ Exemption you should become ZONE: - BY: -
subject 'to the Workers' Compensation provisions of the of,
Code, you•must forthwith Minimum Setback Distances:. -
comply with such provisions or this permit shall be deemed revoked. - - - '
Front Setback frcrn Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line -
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.) Side Setback fron Property Line
Lender's Name
Lender's Address " FINAL DATE- INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is, suspended for 180 days.
I certify that I have read this application and state that the above information is°correct. 'Issued by:-'- Date' 6/ /90 Permit- '
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. Validated by:
Signature of applicant Date +.
Mailing Address Validation:
City, .State, Zip.
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ. FT, ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/4c
HOUSE SEWER
FRAMING
FINAL INSP.
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 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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION lG
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL