RPL (11273)4�,
3 P.O. BOX 1504 N o . 1.12 7: 3
Buildin r,. iEY1:1�3 7&105CALLEESTADO
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Address ' LA'QUINTA CALIFORNIA 92253
Owner -Hector La Marcue %
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Mailing r .. BUILDING: TYPE CONST. OCC: GRP.' _
Address S&7�t&� A.P. Number
Cil
a tt�;�a Zip 9225? ]Tel.
Legal Description
Contractor- -
western Pools
Project Description
.._.Address..__ - POOL AND SPP.
43-375 Madison St..
city. . Zip Tel.:
Inch® 92201 347.55959
State Lic. City
& Classif. 348768. `',5.3 Lica# i:51. Sq. Ft. No. No. Dw.
Arch.; Engr.,
-.Size. Stories - • Units •• r
• Designer New ❑ Add'❑ , Alter O • Repair 0 Demolition O'
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 • i ,
7000) of DivWon 3 o the ktsiness and professions Code, -and my license is in full force and
SIGNATLRE _. DATE _ _ .. .. •-� -
u. OWNER -BUILDER DECLARATION
f I hereby affirm Mat I am exempt from the Contractor's License Law for the following Estimated. Valuation • $1000,
f ' dirt!m tt
reason: (Sec.. 7031.5.�siress and Professions Code: Any city or county. which requires a '3 ®r 00 63,'
permit to construct, ager, irprove, demolish, or repair any structure, prior to its J&wance .also '
•requires the applicant for such pemut to We a signed statement* that he is 8censed pursuant -to PERMIT••. • . - - AMOUNT
` �• the provisions of the Contractor's License Law, Chapter9 (commencing with Section 7000) of ' • -
OWrsion 3 of Me Business, and Pmfessbns Code,. or that. he. is exempt therefrom: and the basis
-, for. the'aleged. exemption.•. Any violation of Section 7031.5. by any applicant. for a; permit .•.. Plan Chk. Dep. - -
subjects the appirard to a civil penalty of not more than five hundred dollars ($500). 's
r❑ I, as, owner of the property; or my employees with wages as their sole compensation, will Plan Chk. Bal: 218.73 -
do the work, and the structure is not intended or offered for. sale. (Sec. 7044; Buisness and „const: 33.8..53
Prolessions Cade: The Contactors, License Law does not ,apply to an owner of property who . - -
builds or improves dwreon and who does such work- himself or; through • his own . employees; ' `� Mech. A n1•m n
Provided that• such irprove ments are not intended. or offered for; safe. fl, however, the building - o V v or 6mprovemerd is sold wAft we year of completion; the owner-budder.wig have the burden �- -
ofprovcglthat heewnot bum orirproveforthepurpose of sale.). Electrical_ i 45.00 .
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-'' Plumbing 7" 27.00'
struct the project (Sec: 7044, -Business and Professions Code:'The Canbector's License'Law _ 3 0 Q
does not -apply to an owner of property -who builds or improves thereon, and, who contracts. for, $:M.I.; .. _ „
such projects with a contractor(s) licensed pursuant to.the.Contractor's License Law.)
• . ❑Lam exempt under Sec Grading B. 8 P.C: for this reason - - ,
Driveway Enc. e '
Date owner Infrastructure '
WORKERS COMPENSATION DECLARATION
I hereby inn that I have a certificate of consent to'self•insure, or a'certificate of
Workers Compensation Insurance; or a certified co thereof, (Sec. 3800, Labor -Code:)
PoIr Noy._company m
O Copis filed with the city. ❑ Certified copy is hereby fumished.-
TOTAL . 55, . 03
-
CERTIFICATE OF EXEMPTION FROM _ +�+ r g cal: C�
WORKERS' COMPENSATION INSURANCE .. REMARKS' - $ 7 L#yk;, 3o;t! j Cry . f } Al``
(This sewn need not be completed N the permit is for one hundred dollars (5100) valuation. -
' or less.)
certify that in the performance of the work for which this permit is issued, I shall not - • .
employ any person in arty manner so as to become subject to the Workers' Compensation,
Laws of California
F
Date Owner
NOTICE TO APPLICAW: 0, after making• this Certificate of Exemption you, should become . ZONE: ' ' w' BY: `
subject'to the WOrliam'. Compensation provftidns of the Labor Code. you must- forthwith'
comply with such provkwm or this permit shall be deemed revoked: - Minimu It Setback Distances:
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
Lenders 'Address y m
This is a building permit when properly filled out, signed and validated; and is subject to . FINAL DATE I NSPECTOR
expiration it work thereunder is suspended for 180 days. -
1 certity that I have read this application and state that the above information -is correct. .r 'Issued -by: - Date Permit
comply-
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. m
mentioned property for inspection purposes.Validated by:
Signature of applicant Date _ 7+
-� Mailing, Address - 'Validation:
city, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. ®
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. 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,TEM/PERM
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+/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
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.
FIN.LINSPo�_
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
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