06254 (RPL)P.O. BOX 1504 No. 06254
Building 78-105 CALLE ESTADO
Address 49-010 SleYamata LA QUINTA. CALIFORNIA 92253 x
Owner
BUILDING: TYPE CONST. OCC: GRP.
Mailing
Address S WW ""' A.P. Number Parc ti Q"xllta �.
City Zip Tel.
La QuInta SIM3 Legal Description
Contractor. Pool b S 8- P
Project Description P
Western Poole ,
Address
43--375 Haillson
City Zip Tel.:
Yiad 92201. 347-59-59
State Lic.City
& Classif. 348765 Lic. # 11511--t- . x Sq. Ft. No. - - No. Dw.
Arch., Engr., Size Stories k Units - -
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition -0
Address' Tel.
City Zip State
Lic. #
LICENSEWCONTRACTOR'S DECLARATION
I hereby affirm that 1 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, Estimated Valuation7a��Q
1 hereby affirin that 1 am exempt from the Contractor's License Law for the followingr
'ts - reason: (Sec. 7031.5,11usiness 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 Me a signed statement that he is licensed pursuant to -PERMIT- - AMOUNT,
the provision9 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 aftaged exemption. Any valation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep..
subjects the applicant to =Any
penalty of not more than five hundred dollars (5500). '
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. $117.00.
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 10
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. Mech. y �q�
provided Nat such improvements are not intended or offered for sale. If, however, the building 64 A0
or improvemenvis sold within one year of completion, the owner -builder will have the burden Electrical lCp RL
of proving that he did not build of improve for the purpose of sale.) 43.00
❑ I, as owner.of'the property, am exclusively contracting with licensed contractors to con- Plumbing 27.00
struct the project` (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not app/y;to an'owner of property who builds or improves thereon, and who contracts for S.M.I.• ���
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading ,
❑ 1 am exempt under Sec B. & 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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. A
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuationor 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 I
Date Owner
NOTICE TO APPLICANT ff, after me" this Certificate of Exemption you should become ZONE: - BY:
subject' to the workers' Compensation provisions of the Labor Code, you must. forthwith - -
complywithsuchprovisions_orthisPer mit shall 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, Civil Code.) r Side Setback from, Property Line
Lenders Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE INSPECTOR
expiration if work thereunder is suspended for 180 days. 9/5/89 ;.
I certify that I have read this application and slate 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 iof - 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. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
FOUND. REINF.
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT. @
GROUT
WATER HEATER SERVICE
DRINKING FOUNTAIN.
WALL SQ. FT.
FINAL INSP.
BOND BEAM
WATER SYSTEM
URINAL
SQ FT ®
GRADING
cu. yd.
plus x$
=$
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
ROOFING
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. @ c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® IVT c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
HOUSE SEWER
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. 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) ER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
'/A
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