15191 (RPL)Qum&
h
P.O. BOX 1504
Building14— 035 OCOTILLO 78-495 CALLE TAMPICO
Addreos LA OUINTA, CALIFORNIA 92253
Owner STAN & SHELLY WYMM4
„y
Address SAME
City QUINTA
Sq. Ft.
Size
112253
ITe S60-9'469
Contractor
. MASTER
POOLS 6 SPA
Address .
�I
73-'555 HWY
Ili
City
Zip
Tel.'
_ P.D
AMOUNT
1 92260
346--6115
State Lic.
& ClassiC 53 238947
City
Lic. # 16
Arch.; Engr.,
5 0 • ty U
Mech.
Designer
Electrical
4:11, . luu
Address
27.00
I Tel.
Ityip I State
IZ
Lic. #
}LICENSED CONTRACTOR'S DECLARATION
I he reb affirm ( t I. rlicenss", rider provisions of Chapter 9 (comme4ing ith S tion
ff�ec)tof yisio of Ixe�Busi sit Professions Code, and my lice e/g if 1 rce and
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bustness 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
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor'sLicense 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 or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civi penalty of not more than rive hundred dollars ($500).
❑ 1, 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 or 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 or sale.)
O 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 contractor(s) pcensed 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy 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 anyparson in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT:, ff, after making this Certificate or 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 (St00,000), 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 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.
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..
mentioned property for Inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
No. 351.91
11LDING: TYPE CONST. OCC. GRP.
P. Number
!gal Description
POOL & SPA
oject Description
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
S;ide- e e back from Center Line
-�� Side�stba m Property Line
FINAL D TE /�I SPECTOR
issued b �r 1 q 1 G%at Permit
Validate by: !!
I
Validation:,i:1 �' �"
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
�I
Estimated Valuation
36 r 5OO. QO
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
111 •40V
Const.
5 0 • ty U
Mech.
Z4.UU
Electrical
4:11, . luu
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
�4-
TOTAL
U
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
S;ide- e e back from Center Line
-�� Side�stba m Property Line
FINAL D TE /�I SPECTOR
issued b �r 1 q 1 G%at Permit
Validate by: !!
I
Validation:,i:1 �' �"
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. ® $
2ND FL. SO. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. 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
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERIA
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
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
r
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING - ELECTRICAL j HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING10
UNDERGROUND
I/ � A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. fFJV
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI ANK
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
FINAL INSP.
GRADING
cu. yd.
$ plus-x$-=$-
lusx$_$ROOFING
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
S / rrYJJJ 11
D
N
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
BISHOP GRAPHICS/ACCUPRESS
REORDER NO. A56285