10565 (RPL)CV
P.O. BOX 1504 No. 10565
Building 78-105 CALLE ESTADO
Address 51--370. Juarez LA QUINTA, CALIFORNIA 92253
Owner
Bob Decker
Mailing BUILDING: TYPE CONST. OCC: GRP.
' Address sarae A.P. Number
City Zip Tel. I
La Qcz3.n•ta 92253 Legal Description i
Contractor Project Description
McIntyre Pools Spas
Address Swimmina Pool Heater Inste^a,.11ation
—+--
46301
-.46301 Roudel Lane
City Zip Tel.:
f
T.a r1v1-t -M+- 42 - .� 2- 352
State Lia City I
& Classif. C53 614621 19
Lic. # 5 Sq. Ft. No. No. Dw.
�
Arch., Engr.,
Size Stories Units
{
Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
I
Address Tel.
City Zip State
Lic. #
f LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
700,0) of Division,3 of the Business•and Professions Code, 'and my license is in full force and i
efffect. /; :
SIGNATURE DATE
"OWNER -BUILDER DECLARATION Estimated Valuation
1
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 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.
•`2�"-for the alleged exemption. Any violation of Section 7031.5 by. -any applicant for a permit Plan Chk. Dep. I
"subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 4
do the work, and the structure is not Intended or offered for sale. (Sec. 7044, Buisness and Const. 45.00
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, Mech.
provided that' such improvements are not intended or .offered for sale. If, however, the building of Improvement is sold within one year of completion, the owner -builder will have the burden Electrical, •' `i
of proving that he did not build or Improve for the purpose of sale.) I
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con Plumbing
Strutt 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 S. M. 1. 2Q
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
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 I
Worker's Compensation Insurance, or a certified copy. thereof. (Sec. 3800„ Labor Code.) _
Policy No. CompanyL �. t r r.
®Copy is filed with the city. ❑ Certified copy is hereby furnished. 1W "� f �j•`t� � F` 4-�+26
TOTAL 4 5. 2 0 i
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation !1
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.
l
Date_' Owner '
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become ZONE: BY:
subject' to the 'Workers' Compensation' provisions or 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 from Rear Prop. Line G
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line j
I hereby affirm that there is a construction lending agency for the performance of the i
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line t
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued : b Date Permit I
I -agree to comply with all city and county ordinances and state laws relating to building y
construction, and hereby authorize representatives of this. city to enter the above-.
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CARP. 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
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
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 ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® V4c
HOUSE SEWER
FINAL INSP.
ROOFING
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
UNDERGROUND
A.C. UNIT
COLL. ARE
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
AGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
`
METER LOOP
HEATING (FINA
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$_=
$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL