15268 (PAT)'
• 44
P.O. BOX 1504. No. 15268
,
Buildin
78-495 CALLE TAMPICO
Address 48-603 Vista '$Tema LA QUINTA, CALIFORNIA 92253
Owner Mr. Ed. Gilreath
Mailing
Address S die
a QLii$°lte3► Zi 92a53
Cityt
Ctrron/trracto�ra ,},,
ruation
Address ..
76--620 Bottlebrush
Llc`iy. Quinta,s CA fiP92253
State Lic. B 4.219115
& Classif. .
Arcn., Lngr.,
Designer
Address
City Zip
LICENSED
I hereby affiralihat 1 am licensed
foo0) of Division 3 of the Business,
**'AftecL / ",c— • "
LDING: TYPE CONST. 1 - OCC: GRP
P. Number
Tel.
564-2176 Legal Description
Project Description Patio Cover
T9'6'4-2-176 64-2176
City 14
Lic. #
Tel.
I State
Lic. #
DECLARATION
of Chapter 9 (commencing with Section
Code, and my icense is1infull force Vol
J . - OWNER -BUILDER DECLARATION - -
1 hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason; (Sec.. 7031.5,Bustness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant ,tor such permit to file a signed statement that hes 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
sujects the applicant to a civil penalty of not more than rive hundred dollars ($500). 1 . •
❑ 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
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 safe. If, however, the building
or improvement is sold within one year of completion, the owner -builder wiD 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 contractors) pcensed pursuant to the Contractor's License Law.)
❑ 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 fumished..
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for.one hundrRo- ars ($100) valuation
or less.) % ,„.r"'
I certify that in the performance of thg work for which'this permit is issued, I shall not
employ any person in any manrter'so as to become subject to the'Workers' Compensation
Daws.of•Cali orni ,}r
Date caner r"$�*^'�./�—'-." �``^•.�.'
NOTICE TO APPLICANT: ft, after making this Certificate ---or Exemption you 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. .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION.TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND
ATTORNEY'S FEES.
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'l 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. I
Signature of applicant Date
Mailing Address
City, State, Zip
Sq. Ft. 240 No. No. Dw. , t
Size Stories Units'.
New ❑ Add ❑ Alter ❑ Repair ❑ — Demolition ❑
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
D '1
Zzwi2 VZ -As Tn72 "o C
Estimated Valuation
$3 192..00
PERMIT `
.'AMOUNT
Plan Chk. Dep.
INSPECTOR
Plan Chk. Bal.
40 . 9 5
Const.
63.00
Mech.
-Electrical
Plumbing
S.M.I.
, 3
Grading
Driveway Enc.
Infrastructure
TOTAL
104.27
REMARKS
_ r
Validation: 1
t; U L v U IJy3 - lJ .4
13 Ci
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:
Validated by:
Date Permit �nf
f II 11 1 I Int
_ r
Validation: 1
t; U L v U IJy3 - lJ .4
13 Ci
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $'
UNITS
COLL. AREA
2ND FL. SO. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING ,
yd.
$ -Plus-X$-
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIREPLACE
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
GAR. FIREWALL
LATHING (�
MESH
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 APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING ,
yd.
$ -Plus-X$-
_$
LUMBER GR.
FINAL INSP.cu.
FRAMING `
FINAL INSP.
ROOFING
0
REMARKS:
VENTILATION
r
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING (�
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Laguna De La Paz
Ai
P.O. Box 799 .
' Rancho Mirage, CA 92270
o (619) 564-8864 ,
FAX (61.9).564-8867 "
°ARCHITECTURAL VARIANCE REQUEST
�!i
UNIT,.# DATE-
NAME ,
STREET ADDRESS'. '
S.
LOCAL -PHONE • # 24— .O % OTHER PHONE.
—T _
To The Architectural Committee:
We, the undersigned owners,_ request your approval of the
' modifications proposed on the reverse'side of this form.
•Attached are.drawings of the.work to-be done; types of material
to be used.are indicated on,.the'drawings. We understand that
'building permits for home improvements-are required by the City
of-La Quinta and that the cost of the permits.and responsibility '
of obtaining-permits and subsequent inspections'will be borne
4 by
• a r
We acknowledge that all approved changes in the original design
-will be at our expense; that -`any damage to or relocation of
existing sprinkler systems, underground utilities, bu l ing
r+�'>N Y•+6: `MNri+"F 1'.uw - i Yh".aF7{ Grt,gtSM�,Y•ir-
,�� uyk,«,srtructure1and�^exteri0fZ ca,P ng�or� otPher„�dam�age�:re ting
tZz9"yffNA'AYFtWN-igh�ar7Fv+�y,rc s_.
;romconstruct4"on,f nth se tperm�tted impro�ements�+cl l at
r iT r ^^ +er,� .�. '�'h�.`r~, ar..xCAla'. x � w, cd. � .' � - y i, .F.. - M;.F ar .Y*' 4ar�+'+i��+y,�yx+� �5
: ay ouY" xpense, and thaxlovma ;ntenanc:e Gof the. perm .tteda.�,im r ements
will be at our expense.
SIGNATURE OF ALL OWNERS,. '
t;
Please provide as much detail as possible so that the committee
may consider approval without delay!
fi C ���� �� .7O
The above proposal has been reviewed by the Architectural
Committee and has been:
APPROVED REJECTED PENDING FURTHER
INFORMATION
%.vuuui L. t -cc 1'1C111idC1