14983 (RPL)P.O. BOX 1504 No. 14983
Building 78-495 CALLE TAMPICO
Address 48-350 Paco Ti!'.>" po Lanae LA QUINTA, CALIFORNIA 92253
Owner
TUDD
Mailing BUILDING: TYPECONST.. OCC. -GRP.-
'
Address P.O. Sox 1716
A.P. Number
CityZip Tel.
La . Quint , CA 92253 771-1941 Legal Description
Contractor
Cal3rornia Pools & "Spas
Add Boardwil A-2
City Zip Tel..
Palm Desert, CA 92211 3 0-9000
State Lic. C-53 656120 City
& ClAssif.. Lic. #
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
OWNER -BUILDER DECLARATION
I hereby, affirm that I am exempt from the Contractors License Law for the following
reason: .(Sec'
7031.5, Business 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 of the Contractor's License Law, Chapter 9. (commencing with Section 7000) or
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 or 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 cnprove for the purpose of sale.)
O 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) #caned 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, ❑ 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) valuafion
or less.)
I certify that in the performance of thF 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
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑. Repair ❑ Demolition ❑
Estimated Valuation $74500.00
PERMIT
AMOUNT
Plan. Chk. Deo.'
'
Plan Chk. Bal..
64.35
Const.
99.00
Mech.
24.00
Electrical
45.00
Plumbing
27-00
S.M.I.
Grading
HUNDRED THOUSAND. DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,
Driveway Enc.
Side Setback from Property Line
Infrastructure
'
ATTORNEY'S FEES.
'This is a building'perrnit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
expiration it work thereunder is suspended for 180 days.
TOTAL
259.35-
59.35REMARKS
REMARKS
"Issued by-
Date Permit
1 agree to comply with all city and county ordinances and state laws relating to building
• NOTICE TO APPLICANT., H; after making this certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
complywithsuchprovisionsorthispermitshaftbedeemedrevoked.
-
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'perrnit when properly filled out, signed and validated, and is subject to
FINAL DATE
INSPECTOR
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.
"Issued by-
Date Permit
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives .of this cityto enter the above-.
mentioned for inspection
Q
property purposes.
Validated by:
Signature of applicant Date'
Mailing Address
Validation:
City, State, Zip
I A P R 061995 I
iu
Bv.
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS '
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ®c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 1A c
SEWAGE DISPOSAL
( j
\l
SQ.FT.GAR ® 3/sc
HOUSE SEWER
VENTILATION
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
UNDERGROUND
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)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus-x$-=$-
lusx$=$ROOFING
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
( j
\l
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