04356 (PAT),r' pt4*Q
P.O. Box 1504'
Building -
78 -105 CALLE ESTADO
Address ��"2,22 Vista � LA QUINTA, CALIFORNIA 92253,
Owner 7 ..
Chamberlain BUILDING: TYPE CONST. OCC. GRP.
Mailing
Address .Sans773-350-025
*. A.P.<Number
City Zip Tel. ..,.,, •
tgj,3lG�, <j• �;��� � ,. Legal Description
Contractor /'� Project Description close patio ani' gets line
Address
to
112201
y Lima
Rall ,
K -
City + .>•. �. :
seidil � E34ER
Tel.
„14�°!6447 ... _.
State Lic.;;4 , >, "
& Classif.„- ' =
` ' ��
City
Lic. #
Sq. Ft.
Size `"
No. No. Dw.
Stories Units
Arch., Engr., .. '
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address;1.::`:-y'•
Tel.
^
City':;<`-.'�,?.r,tY :'
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
' I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) df Division 3 of the Business and Professions Code, and my license is in full force and
effecLey,.(F,1.•n ?'
r• '
SIGNATURE DATE
rn �, OWNER -BUILDER DECLARATION
- ,1, hereby affirm that I am exempt from the Contractor's License Law for the following
. reason:i(Sec. 7031.5,Business 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 or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
s Division 3 or 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 or not more than five hundred dollars ($500).
' 0 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
Professions, Code: The Contractor's License Law does not apply to an owner or property who
Estimated Valuation
e"'
$1 * 500 '
-
PERMIT
'
AMOUNT
. plan Chk. De
P
Plan Chk. Bal.
Const.6Sf
t�1y
r
Mech.
.t 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
oriimprovement is sold within one year of completion, the owner -builder will have the burden
or proving that he did not build or improve for the purpose of sale.)"
Electrical •' "
-•+.'
Plumbing
O 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Seca 7044, Business and Professions Code: The Contractor's Licanse Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M•I•
-
such projects with a contractor(s) licensed pursuant tothe Contractor's License Law.)
O 1 am exempt under Sec. B. ti. P.C. for this reason
Grading
.
'
Driveway Enc.
Date `Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
11 hereby, affirm that I have a certificate of consent to self -insure, or a certificate of
-
Worker's Compensation Insurance, or a certiffied�copy.there f. (Se 3800, Labor Code.)
w �- v>
Policy No. Company
,
N.,Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
REMARKS
CERTIFICATE OF EXEMPTION FROM
S 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 notftS',st�y�.17x3>f
,,� - ''Tta __ffss s";•: ,� ...
employ'any person in any manner so as to become subject to the Workers' Compensation
Laws ofCalifornia.
p-, Vy a'
vfi }r � 3 "9�"�t� 3ga <l��.4*
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate or 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.
ZONE: BY:
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 PropertyLine• —
Lender's'•- Name
Lender's Address ' - ! '
This is a buildingpermit when properly filled out, signed and validated, and is'subject to'
expiration If work thereunder is suspended for 180 days. _
FINAL DATE
SPEC/TOR
* ” ^
' 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.tb building
construction, and hereby authorize representatives sof this city to enter the above-
bove mentioned property for inspection purposes. ,
mentioned
Issued by:'Date
Validated by:
Permit
= = _
Signature of applicant Date
Malling'Address ''
S
Validation:
City, State, ZIP
'
GOLDENROD - ASSESSOR'S OFFICE HARD COPY -FILE'
WHITE FINANCE PINK APPLICANT GREEN BUILDING,
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT !p S
UNITS
SLAB GRADE
2ND FL SO FT. a
BONDING
YARD SPKLR SYSTEM
POR so FT a
MOBILEHOME SVC.
BAR SINK
GAR SO. FT. 0
POWER OUTLET
ROOF DRAINS
CAR P. SO FT. eQt
/SAS (ROUG
( s•
DRAINAGE PIPING
WALL SO. FT. a
OTHER APP.IEOUIP.
DRINKING FOUNTAIN
SO. FT. a
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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
IKITCHEN 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 C t v. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ Vic
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
---j
SMI FEE PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 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.
/SAS (ROUG
( s•
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
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 �. �X
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
,
GARDEN WALL FINAL 71