10064 (RPL)P.O. BOX 1504 N Q . 10064
Building 78-105 CALLE ESTADO
Address 49-245 Balada Ct • LA QUINTA, CALIFORNIA,.92253 '
Owner Childs V
Mailing
Address8c' Me
City
3t Zip Tel.
aQuinta 32253 564-0719
Contractor
F & F Pools
Address
80975 Indio Blvd OC78
City Zip Tel.:
Indio 92201 945 -5070 -
State Lic. City
& Classif. C53 476807 Lic. It 130
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
Je
00)t Division 3 f the Business and ProfessionsCode, and my license is in fu I force nd
T
SIGNATUREDATE
OWN ER - BU I LDERIDECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the following
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 We 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 do8ars ($500).
O 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, Buisness and
Professions Code: The Contractor's License Law does not appy to an owner of property who
builds or improves thereon and who does such work hmself or through his own employees, ,
provided that such improvements are not intended or offered for sate. 11, however, the building. '
I or improvement is sold within one year of completion, the owner-0tufder wiB have the burden
of proving that he did not build or improve for the purpose of safe.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con.
i 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 enproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.),
❑ 1 am exempt under Sec. B. & P.C. for this reason
i
Date Owner
WORKERS' COMPENSATION DECLARATION
A hereby affirm that 1 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
6,Copy is filed with the city. O Certified copy is hereby fumished..
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
=any parson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. It, after making this Certificate of Exemption you' should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
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, Civr7Code.) ,
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 laves 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
BUILDING: TYPE CONST. OCC: GRP.
IA.P. Number
,Legal Description
Project Description
POOL .AND SPA
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
Estimated Valuation
10,500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
81.90
Const.
126.00
Mech.
- 24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
x,.10
Grading
"
Driveway Enc.
Infrastructure
TOTAL
305.00
REMARKS . r
I}li�t�Jt.kt�.'f! l •01_tb0 til 6M.00 Y43
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. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
GAS (ROUGH)/0 BQ /
O 1
DRAINAGE PIPING
WALL SQ. FT. @
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SQ FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
IT SVC
EAMPERES
WATER CLOSET'
COMPRESSOR HP
LAVATORY
HEATING SYSTEM FORCED GRAVITY
ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3AC
IHOUSE SEWER
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE FPL.CK.FEEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING ION91 q/
to UNDERGROUND 7 �LD
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)/0 BQ /
O 1
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
y/l^/! � � � � /� � Z N
h�A� 1! J
�C^� n/ (ASTf `-01,1 fi[
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESfINTTU\LS
GARDEN WALL FINAL