10098 (RPL)1
Building
•4 4 Q'I
P.O. BOX 1504
80575 Cherry
Hill 78-105 CALLE ESTADO
LA QUiNTA. CALIFORNIA 92253
Jack Forrest
Mailing
Address same
City Zip Tel.
La. Quinta 92253
Contractor
M-irage Water Feature
Address
71301 Hive 211
R. JIM. 92270 328-8802
State Lid. City
&Classif. B 522983 Lic.# 571
Arch., Engr.,
Address
City IZip i State
I i LICENSED CPHTRACTOR'S DECLARATION
I hereby affirm that I am licensed u er provisions of Chapter 9 (commencing with Section
7000) of Wialon 3rof the'B-el andtProfebsions Cade, and my license is in full force and
effect. t k; . 1 . e
OWNEWSUILDER DECLARATION
.1 hereby affirm that I am exempt from the Contractor's License Law for the following
. reason: (Sec.. 7031.5,13uskress and Professions Code: Any city or tour), whkh reyulres a
, pemdt to construct, after, Improve, demolish, or repair any structure, prior to ,hs Issuance also
repulrea the, applkarnt for such permit ro !lie a signed statement that he Is licensed pursuant to.
the provIsdons-o/ Ne Contractor's License Law; Chapter s (commencing with Section 7000) of
DMalon 3 of the Business and Professions Code; or that. he Is exempt therefrom, and the basis
for the alleged exemption. Any vk)at/on o/ Section -7031.5 by 'any applicant for -a permit"
st4octs the-applkwnt to a c" penalty of not more than live hundred dollars ($500).
❑ 1; as owner of the property,.or my employees with wages astheir sole compensation, will
do the work end the structure I$ not Intended or offered for sale. (Sec. 7044; Warless and
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;
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 -bunter will have the burden
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 oon-
struct the project. (Sec. 7044, Business and. Professions Code: The Contractor's License Lew
does not apply -to an owner of property•who builds or Improves thereon, and who contracts for
such projects ;vM a contractors) licensed pursuant to Me Contractor's License Law.)
❑ 1 am exempt•under Sec B. & P.C. for this reason
Date - Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -Insure; or a certificate of
Workers Compensation insurance, or'a certified copy thereof. (Sec. 3800, Labor Code.)
Polic No. Company
eL Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred do0ars ($100) valuation
or less.)
I certify that in the performance of'thg work for which this permit is issued, I shall not
employ any ppee T In any mannerso as to become subject to the Workers' Compensation
Laws of V, CT -
Date ,Owner .
NOTICE 70 APPLICANT: H, after making this Certificate of Exemption you should become
subject to the LMorkere' Compensation _ provisions of the Labor Code; you must foiMivBh
comply wflh'such provisions or this pens# ahall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performanceof the
work for which this permit is issued. (Sec: 3087, CMI Code.).
Lenders Name
Lenders Address
This Is a.bullding 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.
1 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 pate
Mailing ,Address
City, State,, Zip
No. 10098
BUILDING: TYPE .CONST. OCC: GRP.
A;P. Number
Legal Description
Project Description
.POOL AND SPA
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
stimated Valuation
24,000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const..
243.00
Mech.
.24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
2.40
Grading
Driveway Enc.
Infrastructure
TOTAL
499.35
REMARKS
.:•�'��u .�91_ i', l�•I�.i1' 1 .•I�:.J %G_i-r
S i 1'ft"�? '1 ! i1
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side,Street Setback from Center Line
Side Setback,from Property Line
FINAL DATE INSPECTOR
Issued by: Date_Permit,
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CARP SO FT ®
OTHER APPJEOUIP.
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN,
SQ FT a
GROUT
URINAL
ESTIMATED'CONSTRUCTION VALUATION =
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOXDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.-
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 316c
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 3 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 INS?— 1 �
FRAMING
FINAL INSP.
ROOFING
>Y
REMARKS -
VENTILATION
FIRE ZONE ROOFING ,
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL.
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL