03925 (RPL)4 925
P.O. BOX 1504
.Buildin78-105 CALLE ESTADO
Address 52-315 Rubio LA,QUINTA,.CALIFORNIA 92253
Owner w.
BUILDING: TYPE CONST. OCC. GRP.
Mailin
Address 52-315 Rubi3Y 7k3-2527015 A: P. Number
City Zip Tel.
La Quinta 92253 � � N , , _ Legal. Description
ContractoraPool � Spa
Project Description
Stahl Co"truction
Address 71-910 Highway 1 11 f Su itt0.4 .
City Zip Tel.
Rancho mirage 02270 .568_9.13015___
State Lic. City
& Classif. Lic. # 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
I hereby affirm that I am Iicensed.u6e'r oroyisions of,Chapter 9 (commencing with Section
7000) of,Division,3'of the:Business a`nd Professions:Code, and my, license is in full force and
effect q
SIGNATURE DATE
• / OWNER.BUILDER DECLARATION
.,-.P`herebyxaffirm that 1 -am exemp('from•the Contractor's License Law.for the following Estimated.Valuation . 000
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
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. e
subjects the applicant to a civil penalty or not more than rive hundred dollars (8500).
❑ I, as'owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 144
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.41i
provided that such improvements are not intended or offered for sale. If. however, the building [� [[��y�
or improvement is sold within one year of completion, the owner -builder will have the burden 'Electrical d tY U V
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- Plumbing 14 r luo
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 S.M.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. 8 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
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE I $$ 5 C 3 t}
(This section need not be completed if the permit is for one hundred dollars (5100) valuation A sAl2 A0 All(I.Th. 10-5_.,�i�` 1914+
or less.)
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.
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
1 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
This is a building permit when properly filled out, signed and validated, and is subject toy
-INSPECTOR
p ryg
expiration if work thereunder is suspended for 180 days.
7 .0 a
/ 3 /
I certify- 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
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING,' GOLDENROD - ASSESSOR'S
OFFICE, HARD COPY -FILE
`FJ
CONSTRUCTION ESTIMATL
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO FT (a $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL SO FT. a
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR SO FT. a
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR SO. FT. iV
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL S �r0
DRAINAGE PIPING
CAR P. SO FT. 0
GROUT
DRINKING FOUNTAIN
WALL SO. FT. to
FINAL INSP.
BOND BEAM
URINAL
SO. FT. rd
GRADING
Cu. yd.
$ plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to t>e used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOYDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SO. FT. ® c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID 1 V. c
SEWAGE DISPOSAL
SO.FT.GAR 3/.c
HOUSE SEWER
FINISH GRADING
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 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
OUGH PLUMBb- ./'
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.IEOUIP.
REINF. STEEL S �r0
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
,
GARDEN WALL FINAL
7d