9794 (RPL)P.O. BOX 1504 t Art,, N 0. 9794
Building78-105 CALLE ESTADO ? sf
Addres51230 ®bragon LA QUINTA, CALIFORNIA 92253
4 F�
Owner 0
Stan Hatt t�
Mailing
BUILDING: TYPE CONST. OCC: GRP.
Address same
A.P. Number
City Zip Tel.
La Quinta 1 92253 1714/857-9170 Legal Description
Contractor Project Description
Mirage Water Features Pool and Spa
Address
Boas 787
City Zip Tel.:
Rancho Mir. 92270 568-0852
State Lic. City
& Classif. 524983 C53 Lic. # 571 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories • Units
Designer New ❑ Add O Alter ❑ Repair ❑ 'Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I �1}EEreby affirm that I amlicensed under provisions of~Ohapter 9 (commencing with Section
70D0) of Division 3 of the Business and Professions Code, and my license is in full force and
'SIGNATURE _ _. - 1 1 4 / \ 1 DATE
OWCL
NER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following 'l®� 00Q
reason: (Sec. 7031.5,Buslness 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 of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
avislon 3 of the Business and Professions Code, or thathe 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. /f
.
subjects the applicant to a civil penalty of not.more than five hundred dollars ($500). .Plan Chk. BBI. 3 9
d I, as owner of the property, or my employees with wages as their sole compensation, will
55
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and COr1St�0� a 00
.,Professions Code: The Contractor's License Law does not apply to an owner of .property who . r�
builds or Improves thereon and who does such work himself or through his own employees, Mech. ' - 2 . V
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 45. 00
or proving that he did not build or Inprove for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con Plumbing 27. 0 0
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.I. 2. 00
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a'certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a
certifi 6�y er
Policy,No. Compay ` o S 3800, Labor Code.)
2'dl copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 439.55
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATIONINSURANCE
(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 thr, work for which this permit is issued, I shall not 4 o11; c re 7 4 _17 r'y'a_.: 4 . Gi
employ any Person in any manner so as to become subject to the Workers' Compensation y+�.r r s
Laws of California ~� ++sr' ,6 1 -ray At. �. '11' r7
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 FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and'validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 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
COLL. AREA
2ND FL SQ. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH)
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL .
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
cu. yd.
$ plus x$
LAUNDRY TRAY
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 ® 1Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.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 9
7 r
//
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINMALS
GARDEN WALL FINAL