9938 (PAT)Tjhf
_ P.O. BOX 1504 N o .
Building 78-105 CALLE ESTADO
Address LA OUINTA, CALIFORNIA 92253
Owner 106-1
ACACIA ROMES
Address
City Zip Tel.
LA QUINTA
Contractor
i:RT SANDS GENERAL CONTRACTOR
Address AVENUE 3E
- 79665 BERMUDA DUPES
City Zip T I.'
il-ERHUDA DUNES I.,
86 1
State Lie. City
&Classif. 539607 Lic.# 686
Arch., Engr.,
Designer
Address I Tel.
City I Zip I State
Lie. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 [commencing with Section
1011, of Division 3 of the Business and Professions Bode, and my license Is in full force and
It .treat. ?�
3"tSNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that l am exempt from the Contractor's License Law for the following
reason: (Sec. 703f.5r&U&ress and Protasslans Code: Any city or county which requlras a
permit 10 construct, alifer, improve, demolrah, or repair any structure, prior to b [ssuance also
requires the applicant for such permit fa file a signed sraremrint that he is licensed pursuant to
Me provisions of fire Contractor's License Law, Chapter 9 (cammericirr9 with Section 7000) of
Division 3 0l the Business and Prbfesskxis Coda, of that. he Is exempt therefrom, and the bases
for the agvged exemption. Any vrofafion of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penally of nor more than five hundred dollars ($500).
❑ 1, as owner of the properly, 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, Buisnoss and
Professions Code: no Contractor's License Law does not apply to an owner of properly who
buitds or Improves thereon and ivho roes such work hirn.sell or through his awn employees,
provided that such Wrovemants are not intended OY offered Ior sale_ if, however, the ttWW;ng
or improvement is said within one year at complefron, the owner -builder will have the burden
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-
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
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date owner
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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (S f 00) 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 na iffarnia. .
Date;
NOTICE TO APPLICANT; If, alter making this Certificate of Ereroptlon you should become
subject to the Workers' CompensaUort 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 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
constrrlCtion, and hereby allthGTize representatives Hof this city to enter the above.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address _
City, State, Zip
LDING: TYPE CONST. OCC. GRP.
A.P. Number
Description
Project Description PATIO COVER
•
Sq. Ft. No.
Size Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$3,013.JrJ
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
M.95
Const.
53.00
Mech.
Electrical
Plumbing
S.M.I.
.40
Grading
Driveway Enc.
Infrastructure
TOTAL
�104.35
REMARKS
ZONE: BY:
Minimum Setback Distances:
Franc 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. ®
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOMESVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 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 GRADE14 V
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS /
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
V
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 y Wcffco�
FINAL INSP.
ROOFING
:�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION g
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL