15812 (PAT)4
f44
P.O. BOX 1504 N o . 15 812
Building 78-495 CALLE TAMPICO
Address 48-601 VISTA TT' LA QUINTA, CALIFORNIA 92253
Owner fAR LOYAL S ItINEB UGH
Mailing SE
Address
City W ;'%253T I4-5' 5i3
Contra- . 'K. T CONST I
Address
77261 F3 IDEEN
C, ys-MMIA, DES 1`922ol
State Ljc0 1 42.915
Arch., Engr.,'
Designer K.T. CONST
Address
Tel.:
345-8042
City
Lic. # 1484
Tel.
City (Zip ( State I
Lic. #
I hereby affirmtthataam licensed,underp visions of�Chapter 9 (commencing with Section
7000) t. � of Divisio ,3,df the Businesslan��
P(ofessions Code, and my license is in full force d
effec
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec...7031.5,Busfness 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 for such permit to rile 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 rive hundred dollars ($500).
❑ 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 sale. If, however, the 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 enprove 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 contractor(s) licensed 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 _
O�Copy is filed with the city.. O Certified copy is hereby furnished.
' r
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit is for one hundred doljars.($100) valuation
or less.)
1 certify thatiNthe performance of;thp w i for which this permit is issued, I shall not
employ;an�pperson in any manner so -as to'become subject to,t to Workers' Compensation
Laws,of Califor i
Date`i��Owner
NOTICE' TO,rA'PPLiCANT: ff, altar making this Certcate ol.,Exemplion yoq should ecb ome
subject to. Ih°e Workers' Compensation provisions of the Lebor Code, you must forthwith
comply wit, such provisions orNis pemii! 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 I have read this application and state'that the above information is correct.
1 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 Date
Mailing Address
City, State, Zip
BUILDING: TYPE CONST.`•` * . OCC: GRP. •
A.P. Number
Legal Description ,
Project Description LATT CE PAT -10"
Sq. Ft. No.
Size Sto
No. Dw.
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
mated Valuation.
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.L.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: • BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street,Seik from Center Line
'Side SeSback from Property Line
FINAL
Issued
Validat,
Validat
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES �
N0. PLUMBINi; FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SQ. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT. ®. •
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT. ®'
OTHER APP.IEQUIP.
DRINKING FOUNTAIN.
SQ. FT. @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN y
WASHER(AUTO)(DISH)
APPLIANCE DRYER
-'FINAL-INSP.
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, TEM/PERM
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 @ 1 Va c
SEWAGE DISPOSAL
GAR. FIREWALL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
LATHING
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
rROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
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 PlyI
FINAL INSP.
71
ROOFING
i
REMARKS:
VENTILATION
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