12581 (PAT)P.O. BOX 1504 N o .
BuildingB 78-105 CALLE ES ADO
Address 48-521 Via Enca*nto LA QUINTA, CALIFORNIA 92253
Owner
Vii. C. SC%'#tohl
Mailing
Address S=e
City 7CA
ip Tel.
La Quihta,, 92253 771-4537
Contractor
Owner/ElUil.der
Address
State Lic. City
& Classif. Lic. #
-Arch.,-Engr.,: /'
Designer
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 Division 3 of the Business and Professions Code, and my license is in full force and
effect.
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,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
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
llie 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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
A I-asowner 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.)
[3 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
f6
Date LL -91/ } Owner F^ r ri
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.
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 thg work,for which this permit is issued, I shall not
gmploy any person in any manner,so as to become:subject to,the Workers' Compensation
,(Laws of California. s,
Date Y3r5'' Owner
NOTICE TO' APPLICANT., If, biter 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 is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subiect 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 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, Zip
125Vt
BUILDING: TYPE CONST. OCC: GRP.-
A.P. Number
Legal Description
Project Description Patio overhang .
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft.
Size 275
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
-Demolition ❑
FINAL DATE
`
Issued by:
FPEC�s
Dateermit
Validated by:
-1 A 19I 3&� ,, �-
�t -t(i t1 L/
Validation:
.
\ Y �y
Estimated Valuation
$.3a602;50
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
'�� •
Const.
*J IJU '
Mech.
Electrical
Plumbing
.S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL`'
y
REMARKS
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
`
Issued by:
FPEC�s
Dateermit
Validated by:
-1 A 19I 3&� ,, �-
�t -t(i t1 L/
Validation:
.
\ Y �y
tip;
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING I
YARD SPKLR SYSTEM
2ND FL. S0. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING I
MOBILEHOME SVC.
BAR SINK
POR. SD. FT.®
GAS (ROUGH)
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT.
GROUT
WATER HEATER
WALL SO FT ®
I
DRINKING FOUNTAIN
SO. FT. ®
WATER SYSTEM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
I
WATER PIPING
NOTE: Not to be used as property tax valuation
I
FLOOR DRAIN
MECHANICAL FEES
I
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN I
WASHER(AUTO)(DISH)
APPLIANCE DRYER
I
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
I
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM I
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT I
SHOWER
BOILER B.T.U.
SO. FT. ® c I
BATH TUB
LATHING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR®Vc
HOUSE SEWER
FINISH GRADING
GAS PIPING
PERMIT FEE
PERMIT FEE I
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE I JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL I HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND I
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING I
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING I
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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
I
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 7d
. I :� •,lam -�.x. � _ �� _ ~. _. _ �� -
' 3- -
_11) E i.A 11/1�
ARCHITECTURAL VARIANCE REQUEST
unit # Date /p l /� ..
Street Address ' 4 i57'UC4,c)6
vocal phone .7 j .h0S,3 other Phone
To the Architectuzal Committee
eye, the undersigned owners, request your approval of the.
modifications proposes, on the reverse side of this fora+.
Atta;hed are drawings of the work to be done; types af'
material to 'be used are indicate0 on the e'rawings. We
understand tnst building permits for home i,mpaovements are
required by the Ci_y of L& Quina and that thl cost of the
Dermit% and responsibility of obtaining pe,tmit.s and
subsequent inspections will be borne by -us.
we'ackowledge that all approved changes in the original
design will be at our expense; that any damage to of
relocation of existing sprinkler. systems, underground
utilities, building structure and exterior laindseaping or
other damage -resulting from construeti'on of these permitted
improvements will best our expense; and that'm'a.intenance of
a' the permitted Improvements will be at our expensie.,
01L
Signature of all owners: �
- _ � �-.fir.; Sv r ,.., i1r� di�:�•witl�R+M4f _ . _ �`� �••.