10844 (RPL)s
P.O. BOX 1504 No. 14844
Building 50-880 NECTARIO LA QUINTA, CALIFORNIA92253
Address _
Owner
Mailing
RANCHO CAPISTRAWO BUILDING: TYPE CONST. OCC: GRP.
-
Address SAME
A.P. Number
City , Zip Tel.
LA QUINTA J 92253 1 564-0705 Legal, Description
Contractor Project Description POOL AND 'SPA,
CALIFORNIA. POOLS AND SPAS
Address
41-910 BOARDWALK
City Zip Tel.:
PALM DESERT 92260 340-9000
State Lic. City
& Classif. Lic. # 355 Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
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
i7000) effectof Division 3 of the.Biisiness and Professions Code, and my license is In full force and
ler -
SIGNATURE4 DATE
} OWNER -BUILDER DECLARATION
Estimated Valuation
Ishereby affirmithat I am exempt from the Contractors License Law for the following $1.32000
reason: (Sec., 7037.5,Business 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- 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
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit. Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars.($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. S-93.60
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisdess and ('ipnSt. 1(; �1.
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.. -24.00
provided that such improvements are not intended or offered for sale.. N, however, the building
or improvement is sold within one year of cornpletkn, the. owner -budder will have the burden Electrical
of proving that he did not build or improve for the purpose of sale.) • 45.00
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 2 7.00
struet 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.I. 1.30
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am -exempt under Sec. R. 8 P.C.-for this reason
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
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company"Ott; {.1 i •_} _, y� i
Copy is filed with the city. q Certified copy is hereby furnished.
ix 10 TOTAL � 3 34...9 O
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollars ($100)—valuation
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.
Date Owner
NOTICE TO APPLICANT. if, after 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 shag be deemed revoked. Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line '
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Cha code.) Side Setback from Property Line
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 if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date 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-.
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
IST FL. SQ. FT. ® $
2ND FL. SQ. 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
UGH PLUMB. /Z J ,K_
FLOOR DRAIN
MECHANICAL'FEES
r
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
AS (ROUGH) (
LAUNDRYTRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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.
s SO. FT. ®c
BATH TUB
BOND BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
LUMBER GR.
SO.FT.GAR ® 3/ac
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 0014VERGROUND
V;#ye_
A.C. UNIT
COLL. AREA
SLAB GRADE
UGH PLUMB. /Z J ,K_
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
AS (ROUGH) (
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$ plus x$
•
=$
LUMBER GR.
NAL INS l 0cu.
FRAMING
FINAL INSP.
ROOFING
/
AA
EMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL