10022 (PAT)P.O. BOX 1504 . NO. IoOZ4
Building 78555 � illeta T,?riv"e 7&105 CALLS ..
Address LA QUINTA, CALIFOORNIARNIA 92253 • )
Owner
Mailing
Mike and Brenda Scarceila / <
BUILDING: TYKE CONST. - OCC: GRA.
Address same .
City Zip ITel,
La Quanta �12�53
-- C3Lt�81L�rr/ffi&tilder
Address
City Zip
State Lic.
& Classif.
Arch., Engr.,
Designer
Address
City Zip
345-8790
City
Lic. #
Tel.
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
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 703 1.5, Business and Professions Code: Any city or county which requires a
A.P. Number
,Legal Description
Project Description PATIO COVER
Sq. Ft. 513 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation20 00
_ '. 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 .
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 Any Section 7031.5 'any for
Plan Chk_.Dep.
-
alleged exemption. violation of by applicant a. permit
subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
-<I, as owner of the property, or my employees with wages as their sole compensation, will •-
Plan Chk. BBI.
a
-do the work, and the structure is not intended.or offered for sale. (Sec: 7044, Buisness and
Const.
90.00
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,
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 w9l'have the burden
Electrical
of proving that he did not build or Improve for the purpose of sale.)
-
p I, as owner of the property, am exclusively contracting with licensed contractors to coo-
Plumbing
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
S.M.I.
i 70
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) -
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date r1 '' Owner_'` '` r <'S�
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, ora'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
REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars •($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not;
,..a"E(:3°''�,.'.'�ae {p_ 'd;$'• t:�y•b j';•�'gls,,.,, ,;,., f�
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date "r.. O,wner if r}. ; „ • s M tlri`•h
NOTICE TO. APPLICANT: ILI alter making this Certificate of Exemption youshould become
ZONE:
BY: '
subject to the* Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
-Minimum Setback Distances:
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.) -
Side Setback from Property Line
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 Date
Mailing Address
City, State, Zip
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:*
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APP./EOUIP.
DRINKING FOUNTAIN.
SO 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
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 V. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 34c
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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./EOUIP.
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 SIGNATURESJINITWLS
GARDEN WALL FINAL