10615 (RPL)1 • ' ` 1 f ..
� � s
i-
• P.O. BOX 1504 No. 10515 / -
Building 54100'.Riviera =78105 CALLE ESTADO ,, :
Address LA QUINTA, CALIFORNIA 9wno2253a \J(
Oer - �• �-•�' r
hn Cooke
Mailing BUILDING: TYPE CONST. OCC: GRP. -
Address game
A.P. Number '
City Zip Tel:
La Qui.nta 92253 Legal Description
Contractor
Project Description'.
California Poor & spas
Address pa only
5
41330 Boardwalk OA2
City ' Zip - Tel:: _
Palm Desert 92250 340-9000
State Lic. City
& Classif. C53 185102 Lic. # 355 Sq. Ft. No. No. Dw.
Arch., Engr.,-.. ..
Size Stories Units
Designer New ❑ Add ❑ -Alter ❑ Repair ❑ Demolition ❑'
Address Tel.
City Zip State
' Lic. #
LICENSED CONTRACTOR'S DECLARATION
1°tiereb -affirm that I am Iicensed.under provisions of Chapter 9 (commencing with Section r
7000) of, ivislon 3•of Uie'lB_"usinneessss and (.Pro�fes+•sions Code, -and my license is in full force and
_SIGNATURE DATE
OWNEWBUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt, from the Contractors License Law for the following 9 '�'�� -
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires.a 1
permit to construct, alter, Improve, demolish, or repair any structure, prior to Its issuance. also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT � - • -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
Division 3o/ 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. - n
subjects the applicant to a civil penalty of not more than five hundred dollars.($500). _ - _ -
O I, as owner of the property, or my employees with wages as their sole compensation, will .- Plan Chk.'. Bal. _ 70'.'.20
- .do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and COr1St. 1 �.� Q O
Professions Code: The .Contractor's License Law does not apply to an owner of property who _ � '
rbullds or improves thereon and who does such work himself or through his own employees, -• -'Mech.
21.'00:'
�i`:'.provlded
that'such Improvements are not intended or offered /or sale. If, however, the building- -
. oi. improvement Is sold within one year of completion, the owner -builder will have the burden.El
->of proving that he did not build or Improve for the purpose of sale.) ..
Electrical 3€9.00-
` ❑ I, as owner of the property, am exclusively contracting with licensed. contractors to con- Plumbing , 24 . 00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License. Law
does not apply to an owner of property'who builds or improves thereon, and who contracts for$,M,I„ .90,
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec. r B. ti: P.C.-for this reason
Driveway Enc. j
Date Owner Infrastructure g
WORKERS' COMPENSATION DECLARATION
Thereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation.] nsurance, or a certified copy thereof. (Sec. 3800, Labor Code.) .
PolIccysjNo. Company
u Oopy is filed with the city. ❑ Certified copy is hereby furnished..'
TOTAL 215 4.10,
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit ls,for one hundred dollars ($ 100). - 00i _r>1,&'^}' j'1• (�,r'j��,'JV,'--:4—C�2
or less.) A V - !.,Y14ri .I. t V• I rli x 4 a'.9 :. a V
I certify that in the performance of thp.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-
comply
Y: '
subject to the Workers' Compensation provisions o/ the Labor Code, you must forthwith IV11nImUmSt?tback 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 INSPECTOR -
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. 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
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT, ®
CARP. SO. FT.
WALL SO. FT. ®
SO 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
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR @ 3V.c
HOUSE SEWER
REMARKS:
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
AL INSP��
FRAMING
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 SIGNATURESIINITIALS
GARDEN WALL FINAL