14447 (RPL)i
P.O. BOX 1504
Building 78-495 cALLE 78-£30 Nolan Circle LA QUINTA, CALIFORNIA9
Address 2253
Owner t r Scott Darling
Mailing
Address 77745 Delaware
Palm bes.ert,.. A,p 92250
Ken Stemmer
..Address
Same
City.- Zip
State Lic.
& Classif.. $ 559937
Arch., Engr.,-
Designer
Address
City lZip
Tel.
Tel.:
City
Lic.# 2373
Tel.
State
Lic. # -
)LICENSED CONTRACTOR'S DECLARATION
I hereby affirm ha Izam licensed under provisions o(sChapter 9 (commencing with Section
000) ofDiyision5 of the bsin ss�nd�ro essions Code, and my license is in full force and .
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 repairanystructure,. priorto its issuance also
requires the applicant for such permit to file a signed statement than 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 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 knprove 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 contractor(s) pcensed pursuant to the Contractor's License Law.) .
❑ 1 am exempt under Sec; -B..& P.C. for this reason
Dale Owner
WORKERS' COMPENSATION DECLARATION
I hereby (firm that 1 have a certificate of consent to self -insure, or a certificate of
Worker's pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy 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 onehundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
No. 14447
BUILDING: TYPE CONST. • OCC. GRP.-
A.P. Number
Legal Description
Project Description ' Poo and Spa
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
Sq. Ft.
Size
No. No. Dw.
Stories - Units
New ❑ Add ❑ .
Alter ❑ Repair ❑
Demolition ❑
Side Street Setback from Center 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 from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE
INSPEC` R
permit whenfilled out, signed and validated, and is subject to
This is a buildingproperly g I
expiration if work thereunder is suspended for 160 days.
Estimated Valuation
4128000.,00
Issued by:
PERMIT
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-. -
AMOUNT
Plan Chk. Dep.
.
mentioned property for inspection purposes.
Validated
Plan Chk. Bal.
87.75
Const..
Signature of applicant Date
135.00
Mech.
Mailing. Address
24.00
Electrical
City, State, Zip
45.00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
318.75
REMARKS
NOTICE TO APPLICANT: N, after making this Certificate of 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 from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS'COMPENSATIONCOVERAGE ISUNLAWFUL, AND
Side Street Setback from Center 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 from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
FINAL DATE
INSPEC` R
permit whenfilled out, signed and validated, and is subject to
This is a buildingproperly g I
expiration if work thereunder is suspended for 160 days.
1 certify that'I have read this application and state.that.the above information is correct.
Issued by:
`' Date era
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-. -
e.
.
mentioned property for inspection purposes.
Validated
O
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. SQ. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. 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 prooerty tax valuation
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
BONDING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
K
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
DUCT WORK
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1'A c
SEWAGE DISPOSAL
BOND BEAM
SQ.FT.GAR ® 3/ac
HOUSE SEWER
GRADING
cu. yd.
$ plus x$
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 A ELECTRICAL ^ HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
1
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC
K
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
�]
1
2 � � � n,�%
7 >
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