14901 (RPL)P.O. BOX 1504
Building78-495 CALLE TAMPICO
52-501 Ave.Address Velasco LA QUINTA, CALIFORNIA 92253
Owner Belknap Construction
Address P.O. Box 297
City
Izip
Tel.
-Palm Desert,? I..A
9226:1
Contractor
Western Pools
Address
4375 Madison St.
Cit -
�Ndio, CA
Zip
92.20
Tel.
347-5959
State Lic.
City
& Classif..
Lic. #
Arch., Engr.,
Designer
Address
Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
d hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of -Division 3 of the Busi and Professions Code, and my license is in full force and
"'y�ffect(� C}�
SIGNATURE ir1 - DATE
V '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, 6nprove, 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
Me 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 c" 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, Suisness 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
orhrprovement is sold within one year or 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 or property *who builds or improves thereon, and.whocontracts for
such projects with a contractors) (tensed pursuant to the Contractor's License Law.)
❑ I 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,-cr a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy N C Company
&I&py 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 thF 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.
bate Owner
NOTICE TO APPLICANT: H, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or Uric 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 ($100,000), IN ADDITION TO THE COST ORCOMPENSATION,
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 160 days.
I certify that I have read this application and state that the above information is correct.
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. .
Signature of applicant Date
Mailing Address
City, State, zip
No. 14901
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description ' FOOL.
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑
'Demolition_❑
INSPECTOR
Issued by:
Date ermi
UQValidated
by:
Validation:
MAR u 0 19 i
Estimated Valuation
PERMIT
$8,006.00 .
'
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
64.35.
.Const. '
99.00
Mech.
24— � .1
'Electrical
45. Qin
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
259.35
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line '
Side Setback from'Property Line
FINAL DATE
INSPECTOR
Issued by:
Date ermi
UQValidated
by:
Validation:
MAR u 0 19 i
CONSTRUCTION ESTIMATE
NO. F,,ECTRICAL FEES
NO. PLUMBIW F€ES
1ST FL. SO. FT. ® $
UNITS
ti
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. S0. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
FOR. SO. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT.
GAS (FINAL)
TEMP. POLE
WALL SO. FT. ®
DRINKING FOUNTAIN
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION_ $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
$ plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
oo,
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRYTRAY
AIR HANDLING UNIT CFM
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING - ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIVG
&6NDERGROUND
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)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
!%
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
ROOFING
oo,
REMARKS:
VENTILATION`S
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL °J�S
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL