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15162 (RPL)• 44-�� P.O. BOX 1504 No. 15162 Buildingr,Q, Ei44 CA—ME ktOAra� 78-495 CALLE TAMPICO j l-iidressLA QUINTA, CALIFORNIA 92253 Owner I RODHOLM !L+ailing Address P.O AOX lib CityjNCHO niR IZip92270ITel- ractor CAL$FOtRN1 1A POOLS & SPA Aaaress A1910 WARDWAMC City' Pp Z�22'sY Tel.:.'14®" 9036 .. State Lic.. City & Classif.. 656128 O 53 Lic. # 355 -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 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, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signedstatement 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 thathe 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 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 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.) OI; 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 confractor(s) Pcensed pursuant to the Contractor's License Law.) O 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. mpanX ❑ Copy is filed with:thecily� l C`e�tPf`ed coPIZ ereby furnished. CERTIFICATE OF EXEMPTIONS FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit Is for .one hundred dollars ($100) valuation or less.) BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description ' POOL ONLY.. Sq. Ft. Size. No. Stories No. Dw. Units New ❑ Add ❑ - Alter ❑' Repair ❑ Demolition ❑ 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:.If, after making this Certificate or 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 shall be deemed revoked.. Minimum Setback Distances: Front Setback from Center Line Rear Setback fromR' Prop. Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setbac om (,`enter 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 fr' rope�� DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. FINAL DATE IN';'P R This is a building permit when property filled out, signed and.validated, and is subject to i expiration_it work thereunder is suspended for 180 days. - ",Permit certify that I have, read this application and state that -the above. information is correct. Issued by: I'agree to comply wfth all city and county ordinances. and, state laws relating to building n construction, and hereby authorize representatives -of this city to enter the , above-:7yn / mentioned property for Inspection purposes: Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip Estimated Valuation . 9,Ot90 PERMIT AMOUNT Plan Chk: Dep.. Plan Chk. Bal. -p- Const. 1 -y Mech.' ?A A-1 Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure , TOTAL REMARKS 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:.If, after making this Certificate or 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 shall be deemed revoked.. Minimum Setback Distances: Front Setback from Center Line Rear Setback fromR' Prop. Line WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Setbac om (,`enter 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 fr' rope�� DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. FINAL DATE IN';'P R This is a building permit when property filled out, signed and.validated, and is subject to i expiration_it work thereunder is suspended for 180 days. - ",Permit certify that I have, read this application and state that -the above. information is correct. Issued by: I'agree to comply wfth all city and county ordinances. and, state laws relating to building n construction, and hereby authorize representatives -of this city to enter the , above-:7yn / mentioned property for Inspection purposes: Validated by: Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES t 1ST FL. SO. FT. ® $ UNITS COLL. AREA SLAB GRADE YARD SPKLR SYSTEM 2ND FL. SO. FT. BONDING HEATING (ROUGH) MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® SEWER OR SEPTIC TANK ROUGH WIRING GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. SO. FT. HEATING (FINAL) WALL SO. FT. REINF. STEEL DRINKING FOUNTAIN. j SQ. FT. ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation WATER HEATER FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GRADING cu. yd. $ plus GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM FINAL INSP. 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 CLD 1 IA c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER GAR. FIREWALL 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 PLU� UNDERGROUNQ 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. FINAL INSP. FRAMING FINAL INSP. ROOFING //J/f��//J RKS: REMA00 of VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL GARDEN WALL FINAL INSPECTOR'S SIONATURESIINITIALS