08869 (PAT)• • all�
P.O. BOX 1504 -` No. 08869
Building 78-105 CALLE ESTADO
Address 44-505 Via Del Monte LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Gaor. L3` Varton BUILDING: TYPE CONST. OCC: GRP.
Address 4 �g Dal Monte A.P. Number
City Zip Tel.
3Legal Description
ta Qvlinta 912 ISContractor Project Description
1 4 ,ne�7
Address Patio Coder
43.580 Pa3m.11a Cis
City Zip Tel.:
State Lic. City
& Classif. Lic. # Sq. Ft. No:_ No. Dw.
Size 695 Stories , Units
<; 'Arch., Engr.,
Designer New O Add O Alter O Repair ❑ Demolition G.
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions.of,Chapter 9 (commencing with Section
7000) of Div ri'3 of the Business and /Professions Code, and my license is in full force and
'effect* / �.. e -•f i a{ r
_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 and Professions Code: Any. city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also r
requires the applicant /or such permit to file a signed statement that heis licensed pursuant to PERMIT AMOUNT
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 applicant for a permit Flan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). - -
❑ I, as owner of the property, or my.employees with wages as their sole compensation, will Plan Chk. Bal. 70.20
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 o/ property who Const. lint
'.'
builds or improves thereon'and who does such work himself or through his own employees. -:•;a-� �•
provided. that' such improvements are not Intended or: offered for sale. If, however, the building ., Mech.
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 /or the purpose of sale.) Electrical
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
slruct 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 /or S•M.l: -
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. & P.C. for this reason Grading '
Driveway Enc.
Date Owner Infrastructure
` 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.)
Policy No. Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 178. 83
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE '
(This section need not be completed if the permit is for one hundred dollars (8100) valuation raRr ren ' A rs +sb C E ..3& .SQA fo
.83emor less.) p�
I certify that in the performance of the work for which this permit is issued, I shall not _ MI I. TOTA .{{•�'
. Vy -M.83-
employ
ploy any person in any manner to as to become subject to the Workers' Compensation
Laws of California.
Date Owner.
NOTICE TO APPLICANT. 1/, after making this. Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
'
comply with such provisions or this permit shall be deemed revoked.
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback.from Center Line
I hereby 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 from 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 if 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 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
fir♦ - �' ..t� t, �''� i c � `> '� t •� � r � � i+ Jr ..F '+}�. � ,.w
1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO, FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WAiER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
/� �
SO.FT.GAR ® V4c
HOUSE SEWER
VENTILATION
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 INS P
FRAMING
FINAL IN .
ROOFING
/� �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FIN
INSPECTOR'S SIGNATURESIINITIALS
GAR EN WALL FINAL