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13440 (RPL):r -- No. 13444 P.O. BOX 1504 Building 7.4-715 Buttercup 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Hal Jones t Mailing . BUILDING: TYPE CONST. OCC: GRP. Address A.P. Number city a Quanta, CE Zip 92253 Tel. L;o v2111 y Pool.- and SPa/va`eriegn Const. Address 4741 C E. Palm Canyon Dr. 4116 City Zip Tela Palms: Springs CA 92264 978-39.39 State Lic. City & Classif. - A `359105 Lic. # 2.565 - Arch.-Engr:, Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby-ajfirm that I am licensed under provisions of Chapter 9 (commencing with Section 7 00) of Division 3of the Business and Professions. Code, and my license iOin full for6e•and Vie+ r" `SIGNATURE DATE OWNER -BUILDER DECLARATION 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 pe,•mit 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 the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of DhIslon 3 of the Business and Professions Code, or thathe 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). 0 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 or completion, the owner -builder will have the burden 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- 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 `•such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. ti P.C. for this reason 4ti - Dale Owner j 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 ❑ 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 dollars ($100) valuation or less.) I certify that in the performance of thg work for which lhis�permit is issued, I shall not employ any person in any manger s to beeccomre4bjedrto the Workers' Compensation Laws of Californias Date Owner%*i`-k� �.'3.i �: ✓.f/'7G'``'li:- '?�,J aNOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become Nsubject 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 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.) 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. 1 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 -of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant -Date- Mailing ateMailing Address City, State, Zip Legal Description Project Description Pool and Spy. 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 Propeer�rty.Line FINAL DATE 'INSP%EICTIOR Issued by: Date 11 (U/ P,grDmit n Validated by: d J 1.90A Validation:y� �✓ Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $14400-00 PERMIT - AMOUNT Plan Chk. Dep. 9121.4-5 Plan Chk. Bal s r Const. ft A /l >• A Mech. ~r nn Electrical 5 ° WW no► nn Plumbing .S.M.I. Grading Driveway Enc. Infrastructure i TOTAL 1 w - REMARKS 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 Propeer�rty.Line FINAL DATE 'INSP%EICTIOR Issued by: Date 11 (U/ P,grDmit n Validated by: d J 1.90A Validation:y� �✓ CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS ROUGH PLUMB BONDING I r • h STORAGE TANK Y ARD SPKLR SYSTEM 2ND FL. S0. FT. @ DUCT WORK ROCK STORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK POR. SO. FT. ® REINF. STEEL GAS (FINAL) Vm TEMP. POLE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS WATER HEATER SERVICE FINAL INSP_ DRAINAGE PIPING CAR P. I SO. FT. ® WATER SYSTEM GRADING cu. yd. $ -Plus-X$-=$ WALL SO. FT. LUMBER GR. DRINKING FOUNTAIN SO. FT. ® FINAL INSP. URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN - MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) 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, 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 ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FENCE FINAL GAS PIPING PERMIT FEE INSPECTOR'S SIGNATURESIINITIALS 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 PLUMBIN UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SE IC I TK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) Vm 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 � / 29 �� 0 n 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 :'-contractor Job Address Owner This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that are on this list are the same persons performing the work. Any changes of this list must be approved by the City of La Quinta Department of Building and Safety prior to work being performed by a changed sub -contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit. TRADE SUB—CONTRACTOR NAME CONTRACTOR'S LICENSE NO. WORKMAN COMP. NO. ON FILE CITY BUSINESS LICENSE NO. EXCAVATE //[ m �D.tl�T,LcPG+�piJ f0�7 PIPELINES CEMENT/ FOUNDATIONS _ CEMENT/WALKS & DRIVES ASPHALT FRAMING _ STEEL/ STRUCTURAL MASONRY PLUMBING //-- LATHING — DRYWALL PLASTERING /SyGjG —lj3 HVAC --- ELECTRICAL ROOFING SHEET .METAL "— FLOORS �— GLASS/ GLAZING _ INSULATION SEWAGE DISP PAINTING/ DECORATING TILE CABINETS/ INSTALLATION ORNAMENTAL METAL FENCES/ BLOCK WALLS A/ LANDSCAPING OTHERS //.xf.t,o ?,Pm,. jvo C�ZJTY OF LA-0-INT BUll-bING & SAFETY lb n EPARTMENT CONDIT101"I'ALLY RL -RUCTiON ACC TED FOR GONlt OJECT TO INSTALLATION AS PER AND ALL APPLICABLE CO -S DATE `/��9� / /�_.`-'I_ - - I POOL AREA TO BE ENCLOSED BY MINIMUM 5 FT. HIGH FENCE. ALL GATES TO BE SELF-CLOSING AND SELF-LATCH11'14G. w 7R-7r� �u��uP