15737 (BLCK)r L0
'i
Address 44-300 Cam a€
Owner
r
P.O. BOX 1504
78-495 CALLE TAMPICO
ada LA QUINTA, CALIFORNIA 92253
Mailing
Address same an above
City Zip Tel.
La
Quina • 2253
Contractor
Q,Jest Pools
Aaaress POO. $OX 31205
"Alm- Desert "p 92255 1e1. 345--5070
State Lic. , ` City
& Classif.. , 476807 Lic. # 130
Arch., Engr.,
Designer
Address Tel.
City,', - Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNEWBUILDER 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
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 Ove 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.)
❑ 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 contractors) 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 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. O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need, not be completed N the permit is for one hundred dollars ($100) valuation
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. O,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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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 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
11LDING: TYPE CONST.
P. Number
No. 15737
OCC. GRP. -
Legal Description
Project Description 14 if of 4' garden wall.
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ . Repair ❑
uation 56. € 0
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
Demolition ❑
AMOUNT
15.00
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear,Sett?ack from Rear Prop. Line
-- ^"Side Street Setback from Center Line
-i-._.
S1detSetback from Property Line
FINAL.DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
STRUCTURE PLUMBING ELECTRICAL ss HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEED
1ST FL. SQ. FT. @ $
UNITS
SLAB GRA
2ND FL. SO. FT. @
ROUGH PLUMB
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. @
FORMS•
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
ROUGH IRING
DUCT WORK
DRAINAGE PIPING
CAR P. SQ. FT. @
S (ROUGH)
WALL SQ. Ff. @
DRINKING FOUNTAIN
SO. FT. @
OTHER APPJEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
GROUT
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
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
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1+/. c
SEWAGE DISPOSAL
VENTILATION
SO.FT.GAR @ 3/ic
HOUSE SEWER
FIRE ZONE ROOFING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE 7T7FEE
STRUCTURE PLUMBING ELECTRICAL ss HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM
UNDERG O
A.C. UNIT
COLL. AREA
SLAB GRA
ROUGH PLUMB
BONDI I
HEATING (ROUGH)
STORAGE TANK
FORMS•
EWER OR SE IC A
ROUGH IRING
DUCT WORK
ROCK STORAGE
FOU D. REIN
S (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REIN . STE L
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAMr4
YSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
^ �/ �
`I
/'d
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL