14505 (PAT)4J136ilding 4$-615 V:ESTA TIES
Address
Owner
P.O. BOX 1504
78-495 CALLE TAMPICO -
LA QUINTA, CALIFORNIA 92253
DON 1-KIARSO AARD
Mailing
Address 48't 515 VI STAT TIEP.RRA
.City Zi :Tel. "'•"
. 2:253 ?Y1-4 718 a.
Contractor
Address 78-9;2`0 . BOTTE EBRUSH '
No. 14%5
BUILDING: TYPE CONST. OCC: GRP:
A.P. Number
Legal Description
Project.Description ' PATIO COVER
530 SQ FT :.
city LQ
92253
Te 64-2176
State Lic. B, 42.1:915
City
-
& Classif..
Lic. #
Sq. Ft.520
No. No. Dw.
Front Setback from Center Line
Size
Stories Units
' Arch:,-Engr.,
Side Setback from Property. Line
Designer
New7) Add'❑
Alter ❑ Repair ❑- _. Demolition ❑
Address
Tel.
•
.City s
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,
- y"
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following -
Estimated Valuation
�+ 16 G
' 16
•
.reason:. (Sec. 7031.5,Business and Professions Code: Any .city or county which requires. a
-
L�
permit to construct, alter, improve, demolish,' or repair.any structure.. prior to its issuance also
I
- -
':-requires the applicantfor such'permit to file a signed statement that he* is licensed pursuant to
_ PERMIT
_ AMOUNT
-the' provisions of the Contractor's License Law, Chapter 9 (commencing with .Section 70.90) of
J -
' Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
•exemption. Any Section 7031.5 'any
Plan Chk. Dep.
- -
-
;•for'the. alleged violation of by applicant for a -permit.
- ' :subjects the applicant to a civil penally of not more than rive hundred dollars ($500).
Plan Chk. Bal.
-
- V y
I, as.owner of the property, or, my employees with.wages as their sole compensation, will
do the work, and the structure is not intended or offered for. sale. (Sec: 7044, Buisness and
COASt:
q
w 00
Professions Code: The Contractor's. License Law does not apply to an owner of.*property who -
•
builds or improves thereon.and who doessuch work himself or through his own emptoyees;
Mech.
-
provided -that such Improvements are not. intended or offered for sale. If, however, the building
_
or Improvement is sold within one year of completion, the owner -builder will .have the burden
Electrical
_
of proving hat he did not build or improve for the purpose of sale.) .. ..
O I; as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
strucP the -project.. (Sec. 7044,rBus-mess and Professions Code: The Contractor's License Law
_
does not 'applytoan owner of property who builds or -improves thereon, and who contracts for
. S.M.I.
such projects with'a contractors) licensed pursuant to the Contractor's License Law.) - -
Grading
.: O I am exempt under Sec. B. & P.C.. for this reason
•
Driveway Eno.
Date Owner
Infrastructure
,.
WORKERS' COMPENSATION DECLARATION '
I hereby affirm. that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof..(Sec. 3800, Labor Code.) -
Policy No.- Company
❑ Copy is filed with the city, ❑ Certified copy is hereby furnished. ' •
TOTAL
CERTIFICATE OF EXEMPTION FROM
WORKERS'. COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($ 100) valuation.
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not'
''employ anyParson in any manner.so as to become subject to.the Workers' Compensation
Laws of California.
Dale Owner
• NOTICE TO APPLICANT., d, after makfng this Certificate of 'Exemption you - should become
subject 'to the Workers' Compensationprovisions 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 it 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 authorizerepresentatives -of this city .to .enter the., above-.
mentioned property for inspection purposes. _
Signature of applicant Date
Mailing Address
City, State, Zip
REMARKS:'
ZONE: •
BY:
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. .Line
Side St[eet Setback from Center Line
Side Setback from Property. Line
FINAL DATE
INSPECTOR
Issued by ' %Date Permit
Validated by:f"�' .
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWU FEES
1ST FL SO. FT. $
UNITS
COLL. AREA
2ND FL. S0. 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 S0. FT.
DRINKING FOUNTAIN
SO. 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 _
cu. 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
IBATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
FIREPLACE
SO.FT.GAR ® 3/.c
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 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. jA jas
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL
.r
L A -G, U
1) E L A -r. A
ARCHITECTURAL VARIANCE REQUEST
Veit. .. ��T'O, Pk9N 3'4cT .2b-Os2-6Date
street Address �6 /J� /�iS?A f �22,q
Local PhoneI6/er) 77Other Phone
To the Architectural Committee:
we, the undersigned owners', request your 'ap)rov'al ,ot 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 ere
required by the City of La Quina and that the cost of the
permits and rvsponsibility.of obtaining Dermits anal
subsequent inspections will be borne by 'US.
,
we ackowledge that al'l approved changes in'the original
design will be at our expense; that any damage to or
relocation of existing sprinkler systems, underground
utilities, building structure and exterior landscaping or
other damage resulting from construction,of these -permitted
improvements will be at our expense;..end that maintenance of
the permitted improvements wi11 be it our expense.,
Signature of all•.owners:
Please pr2vide as much detail as possible so that the
Committee may consider approval without.delay!
PA• i / o dltle';2 /4
1'��2
The above proposal has been reviewed by the Architectural
Committee and has been:
APPROVED REZECTED PEN04ING FURTHER O
O INFORMATION
Comments:
0 A T 'c
�Committee Committee Committee
Member VP_f}Ih PT mpmhpP