09049 (PAT)r
P.O. BOX 1504i No. 09049
Building 78-105 CALLE ESTADO
Address 48-103 VISTA CIBL® LA QUINTA, CALIFORNIA 92253 '" ,,L
Owner .+ PATIO
i JOHN RARMAK BUILDING- TYPE CONST.
Mailing
City lZip JTeL
Contractor
Address
ly IZip
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
Ci tyIZip I State
Lic. #
/'LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thatif am licensedfunder provisions of Chapter 9"(commencing with Section
7000) of Divi�sion_3 o(f�tha Businessss'and Professions Code, and.my license is in full force and
effect. :: ''1 9 .4, 6ei
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
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
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
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, euisness 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,- tfie 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 or sale.)
01, 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
. l -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.)
4..
' .OiI am exempt under Sec. B: & P.C. for this reason
. f
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
O Copy is filed with the city. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
1. WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for. one hundred dollars ($100) valuation
or less.)
} 1 certify that in the performance of thg 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. t
Date_ JCc Owner i ,^.# t .*:y.,•,..v. :/..�9%�.e.
NOTICE -TO `APPLICANT: If, after mitring"this CertiflEMd—of Exemption`- yo 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. t'
JI
4/
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 Dale
Mailing Address
City, State, Zip
A.P. Number
Legal Description
Project Description PA` IO '4)98RHANG
Sq. Ft. No. No. Dw.'
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
3timated Valuation
PERMIT- -AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const: S 00
Mech.
Electrical
Plumbing .
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL YZ•35_ .
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 INSPECTOR
Issued by: Date Permit
. -,,
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ 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 tai 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
LAUNDRYTRAY
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.
SO.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
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
ROCKSTORAGE
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 INSPECTIONS [ '?'! L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL