15209 (RPL)P.O. BOX 1504 ' No. 15209
Building78-495 CALLE TAMPICO
A& res; 44-520 Saffron Ct. LA QUINTA, CALIFORNIA 92253
Owner
Sorous -
Mailing
Address '
44-520
Saffron
Ct.
City@@
Zip
Tel. '
:a. (Aldnta
s
92253
Contractor
Master
Pools &
Spas
Address ..
73-555
Hwy 111
A
City "
Mech.
24.00
Zip
45.00
Tel.:
Pa4a
Desert
92260
346-•6115
State Lic.
&'Classif.. C:53--238943
Infrastructure
City
Lic. # 16
Arcn., tngr.,
Designer
Address Tel.
City ( Zip ( State
Lic. #
A LICENSED CONTRACTOR'S DECLARATION
I hereb affirm that 11am,licensed under provisions of Chapter 9 (commencing. ith Section
,,000) of ivision 3 f fhefBtisiness d f�rofes�sions Code, and my licen " is in ilMorCe and
effect Aa � /// i
/�LDNATUR .''�SY ( DATE
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bug1ness and Professions Code: Any city or county which requires a
permit to construct, after, rove, demolish, or repair .any structure, prior to its issuance also
requires the applicant for sucA permit to rife 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 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 LICensd 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 wifhln 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.)
❑ 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 contractors) licensed 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 Com nsatton Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No Company
16opy 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 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. ft, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
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,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,' INTEREST, AND
ATTORNEY'S FEES.
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 160 days.
I certity 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
BUILDING: TYPE CONST: . OCC: GRP.
A.P. Number
Legal Description
Project Description 141 X 30# Pool & i r X 61 Spa
REMARKS
ZONE: BY:
Minimum Setback, Distances:
Front Setback from Center Lip
Rear Setback from Rear Pr,�N� ' ems.
Side Street Setback fromf0e Line
Side Setback from Propr y Line a
FINAL DATE INSPECTOR
J' .( tr
/I V
Issued by: Date Permit z.. %
Validated by:
Sq. Ft.
Size -
No. No. Dw. '
Stories -Units
New= Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated. Valuation
$13,600 .00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
99.45
Const.
$153.00
Mech.
24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
$ 3 4 S -. 5 .
REMARKS
ZONE: BY:
Minimum Setback, Distances:
Front Setback from Center Lip
Rear Setback from Rear Pr,�N� ' ems.
Side Street Setback fromf0e Line
Side Setback from Propr y Line a
FINAL DATE INSPECTOR
J' .( tr
/I V
Issued by: Date Permit z.. %
Validated by:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINu FEES
IST FL. SQ. FT. ® $
2ND FL. SO. FT. ®
FOR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
SO. FT. ® c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
HOUSE SEWER
FRAMING
FINAL INSP.`
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 Al� ELECTRICAL A HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBI
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
'BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC T N
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.
FINAL INSP..
FRAMING
FINAL INSP.`
ROOFING
/ A
r\j buy
_ V�v
\�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING r
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
Y
a.
TATE---... I!f scA
= I�i DWN..BY
JG Apht C9 �DRD R . AG T9
R � L NO 464
a I -
NAME
�
AOOREss
A -'
CITY
PHONE'
AREA
111 CHK. BY
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