11099 (RPL)s�.
Building
Address 58-953 PINEaURSi
ROBERT MILLS
Mailing
Address SAME
City Zip
LA QUINTA 92253
Contractor
CALIF FOOLS AND SPAS
Address
41-910 BOARDWALK A-8
P.O. BOX 1504
78-105.CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
No. 11099.
BUILDING: TYPE CONST. OCC: GRP.
Number
Legal Description
Project Description POOL AND SPA
CityZip
Tel.:
PALM LSERT
92260
340-90€30
State Lia
City
& Classif. C-53 185102
Lic. # 355
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
-'
Alter ❑ Repair ❑ Demolitiori ❑
Address
Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebyy,affirm.that I am licensed under provisions of Chapter 9 (commencing with Section
7000)of. Division''3:of+the.B l` iness•an 'Professions-Code,_and my license is in full force and
effect.
"'�a•
_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
permit 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
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'rive 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. (Seca 7044, Buisness and
Professions Code: The Contractor's. License Law does not apply to an owner of property who
builds & 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.)
Estimated Valuation
$24,000
PERMIT
AMOUNT
Plan Chk. Dep.._
Plan Chk. Bal.
99.45
Const.
15 3 O �,
Mech.
2 4 X 0 0
Electrical
45.00
Plumbing
27.00
❑ 1, 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.) -
❑ I am exempt under Sec. B. 8 P.C. for this reason
S.M.I.
L
-1. 4 0 ,
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 -NO. Company cttti5' t(3 `j�Vol r(1 ,r;r_ a {f O 9 W
Copy is filed with the city. . ❑Certified copy is hereby furnished.
-r` TOTAL $349.85
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE .
(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' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY '
I 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.
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 Address
City, State, Zip
0
REMARKS
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 Property Line
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO. FT. ® $
UNITS
SLAB GRADE
2ND FL SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
OVFMAL INSP2
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
//�1 _` GJ
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR Hp
POLE, TEWPERM
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 ® 1 Vi c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® -Yic
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
D PLUMBI
RGROUND
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 APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
OVFMAL INSP2
FRAMING
FINAL INSP.
ROOFING
��/� (/� /
//�1 _` GJ
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINt71ALS
GARDEN WALL FINAL
t
TED BY THIS
ALL CON MOST BE NpZ14WEDDEBRIS
FROM THE COMPLEX MDAILY
ODIFICATION
P" WW no== "Umm.ING ,
Date SrZ.w Q Z_
Homeowner Applicant Namtls)
Address
-1'P I V
Telephone S5
lPrimary Residence)
i51le>
CNIci
Ancel
C�rq '3 P. Tract - _ Lot
PGA, West Address
afl SPA .a
CO S%
Modification lsl Requested �o01-- o, `
Work schedule Commencement Date �D
Completion Date 7 — C>
S
Contractor W
`.Fo2.J �r�► o` A•Jc� PS
TO THE ARCHITLCTMU CONMITTLL: ci and
hed
You are hereby advised that the above work ispropose materials to be approval requested.
Us•daIndicatedtoncthe
is a orawinq of the work to be done and type
drawings. 'do understand that building permits for home impsovements are required by the
City of La Guinta and that- the cost of the permits and responsibility of obtaining permits
and suosequent inspection will be borne by the es -the applicant. or
We acknowledge that all approved chang..iniginal design will be at our expense;
to building structure, or other damage resulting
that any and all damage from the._
r's
conatrsction of the proposed improvement shall be at our. lownelicantne
sexpensetiandlthe
any maintenance of the permitted Impsovements shall be at the app
applicant agrees to holo the PGA West Residential , defend andociation hold sharmless for e PGA West
West
maintenance of same. Homeowner agrees to indemnify,
Residential AasoCi t+ n, its officers, agents and employees from any liability arising from
execution of this p i tion. `*� /
signatures of
all owners
/ ARCHITECTURAL CONTROL COMMITTEE
JConditionally Approved Disapproved
Approved
Reason for Conditional Approval or Disapproval
Date �t `1�y Signature
u,aifiControi Committee CGairman
addition to tris approval, you must obtain City approval for the requested modification
In
Inwell as building ocher necessary building permits. You are required to suamit evidence of
as the Association approval to obtain the building permit. For this purpose, all blueprints
and ?fans will be emoossed with the Association's seal, the signature of the Property
c
Manager, and the date of the approval.
^ Date
Completed Work signed off by