14343 (RPL)44 }
P.O. BOX 1504 No. 14343
Building 48-365 Paso Tempo 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Owner Bob Lawry
Mailin 9 S>1iEf e
BUILDING: TYPE CONST. OCC: GRP.
Address
A.P. Number
CityZip Tel.
La Quintan CA 92253 Legal Description
Contractor
Wee iLta Pools Project Description '
Add r.5es
3"' .s. BOX 04 i
syn e, C:�► zip 92201 Tel.:
State Lic.City
& Classif.. G53. 3 .763 Lic. # Ii* -
I Sq. Ft. No. No. Dw.
Size Stories - - Units
Arch-, Engr.,
Designer New ❑ Add ❑: Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed unper• provisions of Chapter 9 (commencing with Section
7000) of Division -3;W466 Busirnesjand .Professions Code, and my license is in full force an
-� effect ' 6 -t -• �/ .. f
SIGNATURE DATE
OWNER -BUILDER DECLARATION t1 rtA�t
I hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation $16 f 000 * Oa .
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires.a
permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also - AMOUNT
requires the applicant for'such permit to rile a signed statement that he is licensed pursuant to - 'PERMIT - . - -
the provisions of the Contractor's license Law, - Chapter 9 .(commencing with Section 7000) of
DiOslon 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 Plan Chk. Dep.. y �f aa 1
subjects the applicant to a civil penally of not more than five hundred dollars (8500).
❑ 1, as owner of the property, or my.employees with wages as their sole compensation, will Plan Chk. Bal. 1 1.
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 COr1St. 171.'00
builds or improves thereon and who does such work himself or, through -his own employees. Mech. - - 24.00
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 Electrical 45.00
.of proving that he did not Wild orsnprove for the purpose of sale.) -
❑ I, as owner of the property, am exclusively contracting with. licensed contractors to con- Plumbing 27.00
struct the project. (Sec. 7044, Business and .Professions Code: The Contractor's License Law
does not apply to an owner of property who Wilds or improves thereon, .and who contracts for S. M.1.
such projects with'a contractor(s) licensed pursuant to the Contractor's License Law.)
' O I am exempt under Sec B. 8 P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
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�q� Company
l b&opy is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL 3 i S. 3 5
CERTIFICATE OF EXEMPTION FROM REMARKS .
• • WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is _for, one hundred dollars ($100) valuation- -
oi 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. N, after making this Certificate of Exemption you should become ZONE: ' - BY:
subject to the Workers' Compensation provisions' of the- Labor .Code, you must forthwith
comply with such provisions or this permit shah be deemed revoked. .. Minimum Setback Distances:.
Front.Setback from Center Line
Rear Setback from Rear P op �Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE ISUNLAWFUL ,AND - Side Street Setback from nter h• e
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES•AND.CIVIL FINES UP TO.ONE
HUNDRED THOUSAND DOLLARS ($11X),000), IN ADDITION TO THE COST OF COMPENSATION, Side Setback from Prop Lin
DAMAGES AS PROVIDED FOR IN SECTION3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEYS FEES. !r/
Tfiis is g permit when properly filled out, signed and validated, and is Subject to a buihijn FINAL DATE INS
P, CT0 1
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 /�. Per 90 i
1 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 -._Q J/
mentioned property for inspection purposes. Validated by: �"
Signature of applicant Date U/
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. S0. FT.
WALL SO. FT. ®
SO. 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 APPJEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
(� D
!�
SO.FT.GAR ® 3/ac
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 APPJEQUIP.
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
(� D
!�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
'
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL