11026 (PAT)y ' i
4-4 a
P.O. BOX 1504 �, �f No. 11026
Building a 9 7&105 CALLE ESTADO
Address 8' 580 V1"�.letal Drive LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Jerome J Ku rtik
' BUILDING: TYPE CONST.00C: GRP.
Address Garde 8G above A.P. Number
City Zip Tel.
La Ouinta 92253 345-9121 Legal Description Lot 2015 orad 23269
Contractor Project Description Patio Coiter
Address
City' Zip Tel.:
State Lic. City
•
& Classif. Lic. # Sq. Ft. No.. NADw
Arch., Engr.'
Size 220 . StoriesUnits
-
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 9 (commencing with Section
t
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effec
s17GNATURE DATE '
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following . 2,882
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires 'a
permit to construct, atter, 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 Pofessions 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 penaky of not more than five hundred dollars.(8500):
I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. BSI. 35. 1 0
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and 54.00
Professions Code: The Contractor's License, Law does not apply to an owner of property .who Const.
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 will have the..burden . Electrical
-
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- Plumbing
slruct 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: a 3.Q
such projects with a contractor(s),licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date ownerInfrastructure
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. O Certified copy is hereby furnished.
c TOTAL -"t9: 40
CERTIFICATE OF EXEMPTIONFROM
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
-=any person in any manner so,as to become subject-to.Ahe%Workers'.Compensation
Laws of California. )
Date Owner
NOTICE TO APPLICANT.—If, after making this Certificate of 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.
CONSTRUCTION LENDING AGENCY
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.)
Lender's Name
Lender's Address
This is a bullding permit wher, 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 authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant G Date
Mailing Address
City, State, Zip
REMARKS
4111-
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: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SQ. FT.
GAS (ROUGH)
METER LOOP
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
LUMBER GR.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
SPARK ARRESTOR
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 APPJEQUIP.
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
►�R 7
" ` / �[
I
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 SIGNATURES/INITIALS
GARDEN WALL FINAL