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RPL (12403) + PLGB (12262) + BLCK (002838)52480 Avenida Madero 12403 12261 002838 1, ,•Lk r " . Building -52-410 Hadero Address Owner Robeit Atkins Mailing Address Same City Zip 4 rel. La Qudni ra., ' . 2?53 Contractor ' 4 ,",Cintyxe Pools a Spas Address + ' Oar fxL;3ii a CA. Zip 92253 Te _ 42-3521 State Lic ; = City._ & Classlf. `--'0;-53`614611 61.461. Lic. # -.1995 Arch: Engr ;. j -4 Designer ""'`w .• Address s Tel. _ ! '', City , -5 t, . Zip State ' ti Lic. # ',LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION l I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 703 1.5, Business and Professions Code: Any city ori county which requires a permit to construct, alter, improve, demolish, or repair any structure, I prior to its issuance also requires the applicant for such. permit to file a signed statement that he is licensed pursuant to 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 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 do the work, and the.stiucture is not intended or offered for sale. (Sec. 7044, auisness and Professions. Codd:iTAB:'CO4tractor's License Law does not apply to an owner of property who builds or improves, ttiereon ;and who does such work himself or through his own employees, provided= thaf:.suctiimprovements are not intended or offered for sale. If, however, the building or improvement Ise'sold-'-within one year of completion, 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.) O 1 am exempt under Sec. B. & P.C. for this reason 4 P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 BUILDING:, TYPE CONST; A.P. Number Legal Description Project Description pool V. Sq. Ft. r No. No. Dw. = E - Size Stories Units New ❑ Add ❑ Alter ❑ Repair❑ Demolition ❑. 'C mated Valuation $10,000.00 PERMIT Plan Chk.`Dep.,•• Plan Chk. Bal. Const. Mech. - Electrical Plumbing S.M.I. AMOUNT,", 4 •s 0 <j. :.a U ,.. d'/aSl' Grading Driveway Enc. Date 4 •-Owner Infrastructure WORKERS' COMPENSATION DECLARATION 7 1, 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. O Certified copy is hereby furnished. ` TOTAL f• CERTIFICATE OF EXEMPTION FROM REMARKS :WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for one hundred dollars ($100) valuation or less.) r ' 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 California. - . )i Date - Owner f NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become ` ' ZONE: BY: .iiii4W 0 Wil subject to the Workers' Compensation provisions of the Labor Code, you must forthwith -^• comply with such provisions of this permit shall be deemed revoked. Minimum Setback Distances: Front Setback from enter Line 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.) x 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 construction, and hereby authorize representatives -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip Rear Setback from Rp Prop. Line Side Street Setback from Center Line Side Setback from Property Line A'..1-41 FINAL DATE INSPECTOR Issued by: Date Permit Validated by: j Validation: ~ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS ROUGH PLUMB. BONDING 2ND FL. S0. FT. STORAGE TANK YARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. REINF. STEEL DRAINAGE PIPING WALL SO. FT. DRINKING FOUNTAIN. SO FT ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER SYSTEM FINAL INSP. q -1—L FINAL INSP. — WATER PIPING NOTE: Not to be used as property tax valuation LUMBER GR. FLOOR DRAIN MECHANICAL FEES ii to A )!—t7 _9 3 LA 1! t WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 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 ® 11/a c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER 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 & AIR COND. SOLAR SETBACK GROUND PLUMBINGD—Z7 DERGROUND -Z7`r? (vi 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 APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP. q -1—L FINAL INSP. — GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING ROOFING ii to A )!—t7 _9 3 LA 1! t REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION zl— CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL ceit 4,4 P.O. BOX 1504 ' N o . 12261. Building78-105 CALLE ESTADO AddresM, ii -470 vl3dero LA QUINTA, CALIFORNIA 92253 Owner virs., . iOber-t Atkind . h•" r BUILDING: TYPE CONST. Mailing OCC: GRP. c; p Address ' r ae •' `L A.P: Number CityZip Tel. 1 .LS N't]C tla, `-CAI 92253 Legal Description. Contractor' `• " _ Project Description Sewer' Connect Her dtic son Constunction, , Adftss3 , -• Ci I Rom ._ <:.r City C fil cl City Zip - 92234 : Tel128-1747. 3281'747 - S State Llc & Classif t Z City Lie. # 194•x., ,. Sq. Ft. h No. ` Size - Stories Arch: Engr 7 Designer 7 ° New ❑ „Add ❑ s` Alter ❑ Address q' ' Tel. .' City j . Zip State Lie. # 6. Side Street Setback from Center Line TOTAL LICENSED CONTRACTOR'S DECLARATION ' 'I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t. of D iIvfissiofnni3 o ff.tCtth heBusme sand Proyfe Ions Code, and my license is in full force and at YF JtsA7" 'tic`^i/ " , Side Setback from --Property Line _SIGNATURE - DATE OWNER -BUILDER DECLARATION } y' p 9 Estimated Valuation ra 6 - 00 I hereb affirm that I am-exem t from the Contractor's License Law for the following e reason: (Sec.,.7031:5,Business and Professions Code: Any city orjcounty 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 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)- 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 - subjects the applicant to a civil penalty of not more than five hundred dollars (S500). ❑ I, 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, euisness and Code: The Contractor's License Law does not apply to an owner ofproperty who builds or improves thereon and who does such work himself or through his own employees, provided that suchimprovements 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 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.) ❑ I am exempt under Sec. B. ti P.C. for this reason •' " - Plan Chk. Dep. " Plan Chk. Bal. Const.. Mech. _ ' Electrical Plumbing .S, M. 1. , Grading 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, Ora 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'COMPENSATIONINSURANCE (This section need not becompleted if the permit Is for one hundred dollars '(S100) valuation or less.) I certify that in the performance of th0 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. a Date Owner ' CONSTRUCTION LENDING AGENCY ' 6. Side Street Setback from Center Line TOTAL REMARKS Side Setback from --Property Line - Lender's Name No. Dw. S Units = " `Repair ❑ Demolition O' . r AMOUNT NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: subject to the Workers' Compensation provisions of the Labor Code, you- must forthwith, comply with such provisions or this permit shall be deemed revoked. --BY:— Minimum Setback Distances: _ ` Front Setback from Center Line Rear Setback•''from Rear Prop. Line CONSTRUCTION LENDING AGENCY 6. Side Street Setback from Center Line j 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 I _ Lender's Address FINAL' DATE 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. Q I certify that I have read this application and state that the above information is correct. Issued by: Date mit t 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 I , • Mailing Address .Validation: City, State, Zip _ i; By t CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES ` l 1ST FL. SQ. FT. ® $ UNITS ROUGH PLUMB. BONDING 2ND FL. S0. FT. STORAGE TANK YARD SPKLR SYSTEM EWER OR 66R" ;"'. : POR. SQ. FT. ® MOBILEHOME SVC. BAR SINK FOUND. REINF. GAR. SO. FT. ® POWER OUTLET ROOF DRAINS OTHER APPJEOUIP. CAR P. SQ. FT. GAS (FINAL) DRAINAGE PIPING WALL SQ. FT. GROUT DRINKING FOUNTAIN. SERVICE SQ FT ® URINAL WATER SYSTEM ESTIMATED CONSTRUCTION VALUATION $ GRADING cu. yd. $ plus x$ WATER PIPING LUMBER GR. NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN FINAL INSP. MECHANICAL FEES ROOFING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL - FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY FIREPLACE AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' GAR. FIREWALL COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER MESH BOILER B.T.U. SO. FT. ®c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1+/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FENCE FINAL 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 EWER OR 66R" ;"'. : OUGH 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. FINAL INSP. FRAMING FINAL INSP. ROOFING C -p REMARKS: VENTILATION - FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION O� CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL P.O. BOX 1504 f 78-105 CALLE ESTADO adddess i 5x-470 Am=LA QUINTA; CALIFORNIA 92253 Owner Mailing' BUILDING: TYPE.CONST. OCC: GRP. Address, A.P. Number s City Zjp Tel. .' r tS3c3 . • g2 5321i Legal Description Contractor .rlbl. . . Project Description Address _ .. City ]ZI. p . Tel;: State Lic. City & Classif. . • Lic. # Sq. Ft. No. No. Dw. ..... - :.. . _ Size Stories Units - Arch., Engr., :'.Designer New D: Add°❑ Alter❑,: Repair ❑ -Demolition ❑ Address Tel. City Zip State 3d1 ..3, ..fli8fi2ti Lic. # LICENSEOCONTRACTOR;S DECLARATION I hereby affirm that I am licensed under provisions of Chapter.9 (commencing with,Section 7000) of Division 3 of the Business and Professions,Code, and my license is in'full,force and effect. SIGNATURE .. DATE ... ... ..... .... ... . . , ... • OWNER -BUILDER DECLARATION' Estimated Valuation. . 'I hereby affirm that I am exempt. from the Contractors License Law for the following. '.!°^9;'p' 1`A!1 .. reason: (Sec.. 7031.5,Business and Professions Code: Any city or county, which requires a • Y'' vV permit toconstruct, after, .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. ..:t PERMIT - - " - AMOUNT ' the provisions of the Contractor's License. Law, Chapter. 9 (commencing -with* Section 7000) of. es_ - I... . I' 'Division 3 of the Business and Professions "Code, of 'that: he is' ezemph;tlierefrom, 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 five'hundred dollars ($500)., O I, as owner of the property, or my employees with wages as their.sole compensation, will; - . . Plan Chk. Bal. , 44.52 _, do the work, and the structure is not intended or offered forsale.,(Sec. *7044, Buisness and'.0 V Professions Code: The Contractor's License. Law, does 'not apply to an. owner of property who. ons .'." • 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 .or improvement is sold within - one year. of.'completlonj the owner -builder will have the burden Electrical' of proving that he did not build or improve for the purpose of sale.), , r , , p I, as owner of the property, am exclusively contracting with licensed contractors to con-, Plumbing strucl the,project. (Sec. 7044,. Business and Professions Coder 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. - - - such projectsmith-a contractor(s) licensed pursuant to -the Contractor's License Law.) - • - .53- Grading 0-1 am exempt under Sec. - B. & P.C. for this reason Driveway Enc. ,Date Owner. ` - , f Infrastructure WORKERS' COMPENSATION DECLARATION ,l 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 O. Copy is filed with.the.city.. • D Certified copy is hereby furnished., TOTAL CERTIFICATE OF EXEMPTION FROM • ' REMARKS WORKERS' COMPENSATION INSURANCE .1 .(This section need not be completed if the permit is for one hundred dollars (S 100)' valuation - - - -' or less.). .. .. ., .. I certify that in the performance of tha work for which this permit is issued, l 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: 11, ager making, this Certi/icate of Exempfiorr you should -become . ZONE:' - BY: "' subject 'to" the Workers' CompensWfon 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 1 -hereby affirm that there is a construction lending agency for. the performance of the work for which this permit is i_ssued..(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 FINAL DATE ` INSPECTOR ' / i4r expiration if work thereunder is suspended for 180 days. Lcertify that I have read this application and state that the above' information is correct. -• Issued by: Date "`7 Permit. I'agree to comply with all city andicouhty ordinances and state laws 'relating to building a c Tit _ construction, and hereby authorize representatives -of •:this city to- enter the above-. mentioned property for inspection purposes. Validated, by:' Signature of applicant f1 -Dale Mailing Address Validation: City, State, Zip A 7 1 1 0 1 13 1135:5 Ck HARD COPY > CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. I SO. FT. ® POR. SQ. FT. ® GAR. SQ. FT. ® CARP. SQ. FT. WALL SQ. 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 APP.IEOUIP. 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION 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 GOND. 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 V-16OUND. REINF. / / �7 �v GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. WOND BEAM Il J WATER SYSTEM GRADING cu. yd. —Plus—X$—=$ LUMBER GR. FINAL INSP. FRAMING AL INSP. %$ ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. """ /LFENCE FINAL fy ► �/ / INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL v t, 16 +i t r a `,t a z . + i - 1 I IA No