10637 (PAT)Building
Address 48-536 Via Enna
P.O. BOX 1504 '
roto LA QUINTA CALIFORNIA 92253
1 Robert & Luella brindle
Mailing
Address same
City Zip 11el:
La Quinta 92253 564-2.2'80
Contractor
. ower
/Builder
Address
Zip I Tel.:
State Lic. I 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,Susiness and Professions Code:. Any city or county which requires a
permit to construct, atter, 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
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 6f 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 rive hundred dollars ($500). ' - .. ' '
0ZI$as owner of the property,. or my employees with wages as their sole compensation, will
-
doethe 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.) ..
❑ 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($) licensed pursuant to the Contractor's License Law.)'
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner'`
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 '
. ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished..
CERTIFICATE,OF EXEMPTIONFROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollars ($100) valuation
or less.)' '
I certify that in the performance of'thp7work for which this permit is%sued, I shall not
employ any son in any -manner so as to become subject to the Workers'Compensation'
Laws of California,o% 1
Date Owner �`
NOTICE TO APPLICANT: Il, �aRer making, this Certificate of 6remp'tior7 you should bBcome
` 'subject to the Workers' Compensation provisions of the Labor Code; you musttforthwilh
comply with such provisions or this permit shall 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 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
No. 10637.1
LDING: TYPE CONST. OCC. GRP.-
P. Number
Legal Description
Project Description Patio Cover
r ..
Sq. Ft. 360 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter El Repair ❑ Demolition ❑
Estimated Valuation 01
PERMIT AMOUNT
Plan Chk. Dep.'
Plan Chk. Bal. 46.80
Const. 72.0-0
Mech. '
Electrical
Plumbing
S.M.I. .50
Grading
Driveway Enc.
Infrastructure
TOTAL 119.30 .
REMARKS
4 4 q +-ll�1 f )
' fit+,1 1' L'44191.114,
1 fi,T I' 9`!Y ' �T �
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. 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
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
GAS (ROUGH)
LAUNDRY TRAY
AIR HANDLING UNIT CFM
OTHER APPJEOUIP.
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 ® 1Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® 3'4c
HOUSE SEWER
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
0�� ND. 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
$ 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
i44
�CQ V
;c .13
oF
OWNER-BUILDER VERIFICATION
Attention Property Owner:
An owner-builder permit has been applied for in your name. and
bearing your signature:
Please complete and return this 'information at, your .earliest
opportunity to avoid unnecessary delay.in processing and issuing
your building, permit. No building permit will'be'issued until
this.'verification is received.
1. I personally plan to-provide the major labor an materials for
c truction of the proposed property im rovement a -or no
P P. P P Y P � )
i�l
I- (have/ ave. not signed. an application forading permit for the proposed work-
3. I.hav contracted with the following person (firm) to provide
the :,propose
::construction:
Name
Address A,City
Phone Contractors License No.
4. I plan to provide portions of,the work, .but 'I have hired the
following person to coordinate, supervise. and prcrvide the major
work
Name
Address _. N, City.
Phone. Contractors License No.:
5. I will provi some of the work'but.I have contracted (,hired)
the following person to provide the work indicated: (see attached)
OWN9R'-BUILDER I ATUR.
RPT1