15138 (RPL)P.O. BOX 1504 N o . 15138
Building 78-495 CALLE TAMPICO
Address 45.,.j'�AO Rambl ewnod C'_t _ LA QUINTA, CALIFORNIA 92253
Mailing'
Addres150 E
City
Coruna
Contractor
Address
�rsl�s BUILDING: TYPE CONST. OCC: GRP.
Ikon ..Sw. 202 A.P. Number
Zip Tel.
09-736 0740 Legal Description
V PoolsProject Description
"•
Ci Tel.:
.'Ie Q9
-93lI 9444
State Lica City
& Classif.. 1903.79 'G 53 Lic. # .
Arch., Engr.,
Designer
'Address Tel.
City Zip. State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm th4t I am licensed under provisions of Chapter.9 (commencing with Section
7000) of Division 3 f the Business and Professions Code,.and my license is in full force and_,
effect.
SIGNATt1RP DATE
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,13usiness and Professions Code: Any city or county which requires a
permit to construct. after, 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 or 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 otnot more than five hundred dollars (8500).
❑ 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 or 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 ofpropertywho builds or improves thereon, and. who contracts for.
such projects with a contractors) #tensed 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 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.
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
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'
subject to the Workers' Compensatlon provisions of .the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. '
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ -Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuatlirb' 0m. QO
,
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. 16 -
Const. -
Mech. G
Electrical 4:) • U
Plumbing •
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL UZ
REMARKS
ZONE: BY:
Minimum Setback Distances:
,
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from Center Line "
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, Side Setback from Property Line
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 ' FINAL DATE INSPECTOR
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. 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 ins action purposes. r A Validated by: II
Signature of applicantDate
✓` � *^ t� t j
. Mailing. Address ` Validation:
City, state, Zip MAY 11 199 /1
I
VIBV
ZONE: BY:
Minimum Setback Distances:
,
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setback from Center Line "
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, Side Setback from Property Line
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 ' FINAL DATE INSPECTOR
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. 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 ins action purposes. r A Validated by: II
Signature of applicantDate
✓` � *^ t� t j
. Mailing. Address ` Validation:
City, state, Zip MAY 11 199 /1
I
VIBV
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
YARD SPKLR SYSTEM
2ND FL. SO. FT.
ROUGH PLUMB. jQ
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. Ff. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. SO. FT.
FOUND. REINF.
GAS (ROUGH)
WALL SO. FT.
METER LOOP
DRINKING FOUNTAIN.
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
BOND BEAM
LAUNDRYTRAY
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. Ff. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 PLUMB. FEE
STRUCTURE PLUMBING. A ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBINGUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. jQ
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC A K
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
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
CV t/ C �/ �'•/�'AI/ l J
REMARKS:
'
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
'
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL