11167 (PAT)P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address 78-655 -Villeta Drive LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address Sa`Ze
City Zip
La Quinti 192253.
Contractor
Owner/Builder
Address
BUILDING: TYPE CONST.' OCC: GRP:
A.P. Number
Tel.
.360-.-1784 Legal Description
Project Description Patio Cover
City
Zip
Tel.:
State Lic.
City
& Classif.
Lic..#
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., fngr., •
Designer •
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address
Tel.
City
Zip
State
Lic. #
- LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 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
Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following
'
3 62.40
- reason: (Sec. 7031.5,Business and Protessions 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
Me 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 by- *any. for
Plan Chk. Dep.
-
alleged exemption. violation of applicant a permit
- subjects the applicant to a civil penalty of not more than five hundred dollars.($500).-
.
Plan Chk.. Bal.
29'. 2 rJ
)41, as owner of the ro ert , or m employees
p p y , y p ogees 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.
fa
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 of 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
-
. of proving. that he did not build or improve for the purpose or sale.)..
.Electrical-
_
O I, as owner of the property, am exclusively contracting. with licensed contractors to con-
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.1. --
such projects with a contractor(s),/icensed pursuant to the Contractor's License Law.) -
Grading
_
O I am exempt under Sec. B. 8 P:C ` for this reason. ,_�'
,., ,;-��•.�`"-
Driveway Enc.
.-
{t
Date m Owner %° $`` �"
Infrastructure
ERS"OMPENSATION
. WO DECLARATION
" I hereby affirm that I have a certificate of consent to self -insure, ora certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Com ny
�,. r M
�� A + '? 7 14
❑ Copy is filed with the city.. ❑ Certified copy is hereby furnished.
TOTAL
-+1 { •5 >
7C415
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
employ any person in any manner so as to become subject to the Workers' Compensation'
Laws of California.
Date Owner
NOTICE TO APPLICANT: !f; after making this Certificate of Exemption, you should 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. ' '
-MIf11rI11Un1 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, CIO Code.) _ _
�
Side Setback from.Property Line
Lenders Name
Lender's Address
*and
FINAL DATE
INSPECTOR
This is a building permit when properly filled out, signed'and validated, 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.
Issued by: -
Date Permit'
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.
Validated by:
Signature of applicant Date -
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
2ND FL. SO. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CARP. SQ. FT.
WALL SQ. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SQ. FT. ® c
BATH TUB
BOND BEAM
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SQ.FT.GAR ® 3l'ic
HOUSE SEWER
FRAMING II-floldrP
NSP.
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 II-floldrP
NSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING (D I
MESH
INSULATIONISOUND
' FINISH GRADING
FINAL INSPECTION- I )—
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL