10658 (RPL)Tit, 4
_y
P.O. BOX 1504 No. 10656
Address
p 7&105 CALLS CALIFORNIAESTAD9 � ��
Address 53-225 i?9JrtrCJUtl LA QUINTA, ORNIA 92253
Owner
:dim Virzi
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address same.
A.P. Number.
City Zip Tel.
Quints 92253 564-0855 Legal Description
Contractor Project Description
McIntyre Pools & Spas
Address Pool' .. and Spa
46301 Ro del lane
City Zip - Tel.:
La Quin a 92253 342--3521
State Lic. City
& Classif. C53 614611 Lic. # 1945 Sq. Ft. No. No. Dw.
Size Stories Units ,.
Arch., Engr.,-
Designer New ❑ Add-❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S'DECLARATION
I hereby affirm that I am licensed under.-Provisions of Chapter 9 (commencing with Section
1'7060) of Division 3 of the Busihess nd Professions Code, and my license is in full force and
SIGNATURP'- DATE
OWNER-BUILDER DECLARATION Estimated Valuation '
I hereby affirm that I am exempt from the Contractor's License Law for the following ®�
reason: (Sec. .703 1. 5, Business and Professions,Codo:'Any city, or county which requires a 12
10
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 '
Division 3 of 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 Plan Chk. Dep. +� .
subjects the 'applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ I, as,owner of the property, or my employees with wages-as their sole compensation, will Plan Chk. Bal. 87. % 5
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 135.. Q
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 or 'through his own employees, Mech. - ,, �.
..provided that such improvements are not intended or offered /or sale. I/, .However,. the building ��ll tL
or improvement is sold within. one year or completion, the owner-builder will have the burden Electrical t 4c� e V V
of proving that he did not build or improve for the purpose of sale.)..
O I; as owner of the property, am exclusively contracting with licensed contractors to coo-: Plumbing 27. 00
strucb the project; (Sec. 7044, Business and Professions Code: The. Contractor's License Law 1 9
does not apply to an owner of property-who builds or improves thereon, and who .contracts for S.M.I. - - 1, . tis
such projects with a contractors) 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 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
C5'Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL '32.9.95
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE REMARKSP'1404&6A._.4R'' f. 0-92 s>j
(This sect/on need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) '
I certify that in the performance of th? 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
expiration it 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 statelaws relating to building
construction, and hereby authorizerepresentatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
FINAL DATE INSPECTOR
Issued by: Date Permit:
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL. SQ. FT.
SLAB GRADE
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
FOUND. REINF.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (ROUG 5wclA
WATER PIPING
NOTE: Not to be used as property tax valuation
HEATING (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GROUT
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
SERVICE
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 ® 1Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
FIRE ZONE ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR -
SETBACK
GROUND PLUMBING
4ONDERGROUND3
�aL
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 (ROUG 5wclA
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP
FINAL INSP
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
ROOFING
([C
CIO
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION• lG�
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL