11001 (PAT)s
P.O. BOX 1504
No. 11001
Building48--107 Vista Ciel 3 78-105 CALLE ESTADO
AddresLA QUINTA, CALIFORNIA 92253
Owner
I Francis Jones
BUILDINGS TYPE CONST. OCC:.GRP.
Mailing
Address BaYi`e A.P. Number
w
icity Zip Tel.
La Quinta 92253 Legal Description
Contractor Project Description
Address. Patio Cover
Cit _.
y Zip Tel.:
State Lic. City
8 Classif. Lic. # Sq. Ft. No. No. Dw.
Arch., Engr., •
Size .35.0 Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
e
_SIGNATURE DATE
OWNER-BUILDER DECLARATION Estimated Valuation .
1 hereby affirm that 1 am exempt from the Contractor's License Law for'the following G
reason: (Sec. 7031.5,Business and Professions, Code: Any L city or county .which requires a 4, 5 85 •'
Permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance also.
requires the applicant for such permit to rile 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 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 rive hundred dolhus.($500).
(&jl, as owner of the property, or my employees with wages, as their sole compensation, will Plan Chk. Bal. 46 . R&
do the work, and the structure is not intended or offered for sale. (Sec. 7044; BuisneSs and COrist. (�
Professions Code: The Contractor's License Law does not apply town 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. -
orlimprovement is sold within one year of completion, the owner-builder will have the burden, Electrical
of proving that he did not build or improve for the purpose of sale.)
pi I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
stiuct 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.[. • - - f}
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑�I am exempt under Sec. B: 8 P.C. for this reason Grading
Driveway Enc.
Date OwneN.-i ---`'°'''ta` Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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. O Certified copy is hereby furnished.
TOTAL I n - 3o
CERTIFICATE OF EXEMPTION FROM ' REMARKS
WORKERS'. COMPENSATION INSURANCE
(This section need not be completed if the -permit is for one hundred dollars ($100) valuation
'orless-) -
.. - 3 4
I certify that in the performance of the work for which this permit is issued, I shall not �� i�j�� gj?L3"°LM j w 7
=any person in any manner so as to become subject torthe,Workers' Compensation „ ,
Laws of California.`''
Date Ownerrl JA �'6 ed.. 1" �-Alt,
NOTICE TO APPLICANT: biter making this ,Certificate of Exemption you should become ,ZONE: -��- BY:
subject to 'the Workers' Compensation provisions of the Laborvdode, you must forthwith -
comply with such provisions or this permit shah be deemed revoked. - t M Inimum Setback Distances:.
F " �. " 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.) a ` '' Side Setback from Property Line .
Lender's Name
Lender'.s Address -
jThis is a building permit when properly filled out, signed and validated, and is subject to . FINAL DATE - INSPECTOR
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 Permit
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
Mailing Address Validation:
City, State, Zip }
I-
i
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT:
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. 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'
ROUGH PLUMB.
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
FOUND. REINF.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
METER LOOP
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVCWATER
CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U. _
SO. FT. ®c
BATH TUB
SERVICE
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1+/a c -
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
GRADING
cu. yd.
$ -plus-x$_=$
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
FOUND. 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
cu. yd.
$ -plus-x$_=$
LUMBER GR.
FINAL INSP. -
FRAMING
FINAL INSP.
ROOFING
f
/
l
A
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION-
NSPECTION
CERT.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
REGIONAL OFFICES
Irvine •' Rancho Cucamonga .' ,San•Clemente • -South Bay . Coachella Valley + San Diego
91
w _ ARCHITECTURAL VARsANC_ REQUEST
Unit I Di Vr-,, /7# /tj1
07 r
Street, Addressg�fT/�} �'��
Local Phone Other 'Phone
To the ;Architectural, Committee: '
We, the undersigned ow'ners,-sequest your approval of the
modifications proposed on•the reverse side of this form..
Attached are drawings Of_the work toDe done; types of
ma teria1 a be' used are indicated on the drawings. We
understand that buIlein; perOIts for hove irprovements are
required by the C1_y of :,2 Qu4nta , and that the cost of the
permits ,and responsibility "of obtaining permits and
subsequent inspections will be borne by'us.
We .ackowledge that al.l approved. changes in the original
design rill be at our e,xpense;,that any' damage to or
relocation of existing sprinkler systems, underground
utilities, building s.truct:ure a.nd exterior landscaping or
other damage resulting "from construction. of these permitted
Improvements will be at our expense;.and that maintenance of
the permitted improvements will be at our expense.
Signature of all owners:-���L'�''
. W
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r .
'Li!-- Ce^- J__�tL Ae4_2
,,,� Woa'4
bt
Please pr3vide as much detail as possible• so that the
C.ommi:tee may consider approval without delay!,
The above proposal has been. reviewed by the Ar:hitec:ura:
C. *.nmittee and las been:
APPROVED REZECTED P:V0:4G FUR7HER
INFORM:. T :0v
Comments:
Committee C»mi::te Czmmit:ee
Member mem; er Memoe:
714