13906 (RPL)P.O. BOX 1504 No, 13906
uilding 46-285 Ci2I ieo Palms 78 105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Mailing
t A.hellan BUILDING: TYPE CONST. OCC. GRP.
Address Sim
A.P. Number
City Zip Tel.
LA QIiZNTA 92253 Legal Description
Contractor Project Description POOL & aPA
Western Foals
Address
43a-375 Madison
City Zip Tela
Indio 82201 347-5359
State Lic. City
& Classif. C53 .348758 Lic. # sq. Ft. No. No. Dw.
Arch:, Engr., _ - Size Stories Units
Designer NewKA Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
)-hereby affirm that Lam, licensed under provisibns'of Chapter 9 (commencing with Section
�T000) of Division_ 3 of-the"Business and Professions, and my license is in full force and !�
effect. �7
_SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
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 PERMIT AMOUNT
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 . plan Chk. De
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit p
subects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan ChkBBI1 I • 1
of , as owner of the property, or my employees with wages as their sole compensation, will . . n
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 171.00
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, 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 build or improve 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 1.60 t �f
does not apply to an owner of property who builds or improves thereon, and who contracts for S. M. 1. 1 . &4
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
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
❑ICopy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL 379-75
CERTIFICATE OF EXEMPTION FROM REMARKS
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. IiL
O
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback fromtcenter-Line
1 hereby affirm that there is a construction lending agency for the performance of the //rl/
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Prop rt. Line >_
Lender's Name V V
Lender's Address FINAL DATE -INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to r
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
I agree to comply with all city and county ordinances and state laws relating building
construction, and hereby authorize representatives sof this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant -Date-
Mailing
ate Mailing Address Validation: 1 �_
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIN
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
BONDING
HEATING (ROUGH)
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
SEWER OR SEPTIC TANK
ROUGH WIRING
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
HEATING (FINAL)
WALL SQ. FT.
REINF. STEEL
DRINKING FOUNTAIN
GAS (FINAL)
TEMP. POLE
URINAL
SO. FT. ®
GROUT
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 "�nUNDERGROUND'S
l� !�
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),?—(�Z�
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.g —24!�—Q�
FINAL INSP.
GRADING
,/.,2—cu. yd.
$ -Plus-x$-=$
LUMBER GR.
FRAMING
ROOFING
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
G�
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
POOL
Equi f.
Mc.K F/L
tj
6
3.
Uc. # •
a
348768
P.O. Box 1047 43 375 Madison St., Indio, CA 92201