11629 (PAT)P.O. BOX 1504 P'i o . 11629
Building 78-105 CALLE ESTADO
Address 48-531 Via Encanto LA QUINTA, CALIFORNIA 92253
Owner
Address Same
CityZip Tel.
La Qui.nta, CP.. 92253 564-6927.
Contractor
Address....
City " . Zip Tel.:
State Lic. City
& Classif. Lic. #
Arch., Engr.,
Designer
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Patio cover over rear Feat
Sq. Ft. No. No. Dw.
Size • 36R Stories • Units
New ❑ Add M Alter ❑ Repair ❑ Demolition ❑
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
Estimated Valuation
$4,820_00
reason: (Sec. 7031.5,Buslness 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
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 Any Section 7031.5
Plan Chk. Dep.
alleged exemption. violation of by any applicant for a .permit
subjects theapplicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk.. Bal.
46.00.
O I, as owner 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
Const.
�1 �Q•
Professions Code: The Contractor's Llcense.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,
•,
McCh.
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
Electrical -
-
.of provingthat he did not build or Improve for the purpose of sale.) _ . -
❑ I, as owner of 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 to who builds Improves• thereon, for
S.M.I:
apply an owner of property or and who contracts
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)- -
.50
Grading
• O•I am exempt under Sec. B. t. P.C. for this reason
Driveway Enc.
9p
Date,_7E'E7=r( Owner'" V—#4-^ n;f��e.r� i�X»f�r�&�4`s��
Infrastructure
V V
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. ' ICompany
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
_
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS'COMPENSATIONINSURANCE
(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 the work for which this permit is issued, I shall not
es` fr'<• tl
{ti�1:9 �i �:ft} `= 1r.lt;, ,}'i �•
employ any person in any manner so as to become subject to the Workers' Com pensation
Laws of California. ."t
DateL'syj +l -Owner
NOTICE TO APPLICANT: If,'"altei making this` Certificate 'of7'Exemption you should 46e66me
subject to the Workers' Compensation/provisions of the)OLabor Code, you must forthwith
comply with such provisions or this permirshall be deemed revoked.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
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.
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
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CARP. SQ. FT.
WALL SQ. FT. ®
SO. 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.COOL 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, TEMIPERM
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 ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE 7ONST.
FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING S 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 APPJEQUIP.
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 -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL