12125 (RPL)I
Building
Address 54-21.9 BERMUDAS
Owner
Y10K,
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I
P.O. BOX 1504 N O .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Address SAM
CityZip Tel.
LA QUINTA 92253 664-6478
Contractor
AMERICAN POOL C09STRUCTION
Address .
68-575 SAN PELIEE
CityZip Tel.
CATHEDRAL CT Y 92234 322-6669
State Lic. City
& Classif. C-33 518742 Lic. # 1106
Arch., Engr.,
Designer
Address ` Tel.
City �.-^" '� t J'Zip 1 State
Lic. #
r h LICENSED CONTRACTOR'S'DECLARATION
I I hereby affirm thajo am IicensedlundeGiirovisions of Chapter 9 (co
7000) of Division 3,ol�the Business'a6d;Profeessions,Code, and my lic
I �{f 1f4
(e 1.
with Section
1516NATURE+ �- f > UA]h
OWNER-BUILdER DECLARATION
rl hereby affirm that I am exempt froTNILe Contractor's.,License Law for the following
reason::(Sec. 7031.5,Business and Professions Any -city or county which requires a
,permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
,Permit
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).
❑ 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 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 -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
0 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 Lawl
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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a certificatee o consent t elf -insure, ora certificate of
Workers Cc 9Qan�sNgL surance, or a certified copy thereo (S cns 0, Labor Code.)
Pollc o. t.J%'7 ,,.0 Company. E�,!-+.i�
Copy is tiled with the city..10 Certified copy is,hereby furnished.
CERTIFICATE OF EXEMPTIONFROM/is
WORKERS' COMPENSATION INSURANCE
(This section need not'be•completed if the permit is for one hundred dollars ($100) valuation
or less.) _x�»—. , .J r• I j)' f / 1 .
I certify that in the performande-of thg work for which this permit is,:rssued. I shall not
employ any personjn.eny manner so as to bhcome e6bie6t to the Workers' Comoensation
uate - s ---ywner -.4" x — . - Z r
NOTICE TO APPLICA(JT: If, after makjng this Certificatete of Exemption you should become
subject to the Workers—Compensation provisions of the Labor CofYe, 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, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it 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 sof this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant —Date—
Mailing
ateMailing Address
City, State, Zip
12125
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:
I� z
BUILDING: TYPE CONST.
A.P. Number
.
Legal Description
Project; Description
i
OCC. GRP.
I
POOL (WISH HEATHER)
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$12,500
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$93.60
Const.
144.00
Mech.
24.00
Electrical- .
45.00
Plumbing
27.00
.S.M.I.
1.30
Grading
Driveway Enc.
Infrastructure
TOTAL
V33-4.
V
REMARKS
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1
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:
I� z
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
ROUGH PLUMB. BONDING
r n
STORAGE TANK
YARD SPKLR SYSTEM
2ND FL. SQ. FT. @
DUCT WORK
ROCK STORAGE
FOUND. REINF.
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
REINF. STEEL
GAS (FINAL) TEMP. POLE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
WATER HEATER SERVICE
FINAL INSP.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
WALL S0. FT.
LUMBER GR.
DRINKING FOUNTAIN
SQ. FT. ®
A / n
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'
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FIRE ZONE ROOFING
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH E R(AUTO)(DISH)
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.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. 17/47 UNDERGROUND l�3
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) s�?f4 METER LOOP
/ [
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING
ROOFING
A / n
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION �6
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL