12327 (BLCK)4
P.O. BOX 1504 N o . 12327
Building 50-375 Vista Montana 78-105 CALLE ESTADO
Address LA OUINTA, CALIFORNIA 92253
Owner Dr. Dennis Roberts
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address Same
A.P. Number
City Zip Tel.
%a Qninta, CA 92253 342-6407 Legal Description
Contractor676 sf patio cover/rt
Rancho Mirage Builders, .Inc, Project Description cover/carport
��
160 of 6' high. block wall
db pls7 Stunmit Dr.
C'ty Zip Tel
Ic:atbbdral Citi , CA 92234 321-1050
State Lic. City
& Classif. B 473205 Lic. # .1050 Sq. Ft. No. No. Dw.
Arch., Engr., - '
Size Stories Units
Designer John, `rTogley New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address 5 Panorama Teld'76--667'
Palo. Desert, A 92260 Lict# 916
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I ars licensed undProfevisfons of Chapter 9 (commencing with force
and
o� /� � e ey $8,990.80
affect.
of Division 3 of the Busines's'a'nd Professions Code, and my license is in full..fo�rcie and Ca [
SIGNATURE '-+' p" DATE Block wall 41000.00
OWNER-BUILDER DECLARATION Estimated Valuation$12t990.80
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 AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 93.60
Plan Chk. Bdl.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will 9 A
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 144. Oil
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, Mech.
provided that such improvements are not intended or offered for sale. If, however, the building a
orimprovement is sold within one year of completion, the owner-builder will have the burden Electrical c'
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- 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...91
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 233.51 }
CERTIFICATE OF EXEMPTION FROM REMARKS "
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 lhg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimurn 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 T I 'INSPECTOR F
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
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 SEP 3 0 1993 '
Mailing Address Validation:
JU)
City, State, Zip
(` B�
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
POR. SD. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SQ. FT.
OTHER APP./EQUIP.
DRAINAGE PIPING
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN,
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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. i
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
if)ATHING
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FFE7 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. — S�
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
NAL INSP. ltz
FRAMING 2 —rd
FINAL INSP.
R OFING �V
s
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
if)ATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL'