11617 (PAT)4 uu�ctr�
P.O. BOX 1504 N O .
11617.
Building 78-105 CALLE ESTADO
Address 75--635 Villeta Drive LA QUINTA, CALIFORNIA 92253 �+
Owner
Mailing
J.B. Anderson BUILDING: TYPE CONST. V OCC: GRP. R
Address 78-635 Villeta Drive A.P. Number
City Zip Tel.
La Quintae CA .92253 101311-631-34 81 Legal Description
Contractor Project Description Install patio structures
Owner/Builder
Address
City Zip Tel.:
State Lic. City
& Classif. Lic. # Sq. Ft. No. No. Dw.
Arch:, Engr., • -
Size 270 Stories Units
Designer J.F$. Anderson New ❑ Add ❑ Alter ❑ Repair ❑' Demolition ❑
Address Tel.
501 Sa..Arroyo Pkwy. (21311631-8481
City Zip State
&I;�
P$Cti'.na ,-CA.9 .105 Lic. # SE -°3341
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 130) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $3,537.00
reason: (Sec. 7031.5, Business and Professions Code: Any, city or county which_ requires a
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 o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Divislon'3 of the Business and Professions Code, or that:he Is exempt therefrom, and the basis
for thealleged exemption. Any violation of Section 7031.5 by -'any applicant for a permit Plan Chk. Dep. -
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. 40.95
❑ 1, 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 Const. ` " 63.00
Professions Code: The Contractor's License Law does not apply. to an owner o/ 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 will have the burden Electrical
o/ proving. that he did not build or Improve for the purpose of sale.)
�,, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
strticI the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law.
does not apply to an owner o/ property who builds or improves thereon, and who contracts for S.M.I. .. 4C •
such projects with a contractor(s) licensed pursuant to the Contractor,s'License Law.)
O 1 am exempt under Sec. 137% P.C. for this eason Grading
�,•- _ / Driveway Enc.
Date r5�% jCn r + _ .- -� t Infrastructure
l
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 104.35
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE '
(This section need not be completed If the permit is for one hundred dollars ($100) valuation "'2; _ �.0, tii 1. a {1..ir1;3 _ _ • 1 I7
or less.) - ,.s :.ar�.YY x a-.-r.!',Y� s .. -'Y •,,rs
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate' of Exemption you should become ZONE: BY:
subject to the 'Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
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 FINAL DATE INSPECTOR
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. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
ROUGH WIRING.
DRAINAGE PIPING
WALL SQ. FT.
ROCK STORAGE
DRINKING FOUNTAIN.
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
IKITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
r
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
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.
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$
c$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
_ �
REMARKS:
VENTILATION
FIRE ZONE ROOFING�1/�////
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL