06065 (RPL)Building
Address
A fey Deryk V.
Mailing
Address same
P.O. BOX 1504 No. 06065'
78-105 CALLE. ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. ' OCC: GRP.
A.P. Number Fare % Ovinto
City Zip Tel. h
, � . 92253 32.2- ii27 LegalDescription
Contractor .„P601'aad a
Wif Pools & Spas
Project Description
Address
41-910 Boar13walk A--;2
City Zip Tel.:
Palla Balaert 92260 3413--9000
State Lic. City
& Classif. 1851102 C: 53 Lic. # 355 -
Arch., Engr.,
Designer -
Address' Tel.
City Zip State
Lic. #
_ LICENSED CONTRACTOR'S DECLARATION
I hereb affirm t pl at 1 am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3of-:I`he�B`ussiinesss and;P�.rpf ss:ns Code, and my license is in full force and
effect.; =rte`. �^ .=4`%.-. ? 7 f l
SIGNATURE -- DATE
OWNEWBUILDER DECLARATION '
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason:, (Sec. 7031.5,Busbress and Professions Code: Any city or county which requires a
permit to construct, alter, knprove, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lye a signed statement that 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 Dy '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 kmprovements 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 (he burden
of proving that he did not builder knprove for the purpose of sale.)
❑ 1, 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.unproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec B. & P.C. for this reason
Dater Owner
S
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 have a ce`rfificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy-thereofe(Sec. 3800, Labor Code.)
Policy No company --Z x"C _11k,
O Copy is filed with the city. O Certified copy is hereby furriished. '
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 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
a —_Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY: - -
Sq. Ft.
Size
No.
Stories •
No. Dw''
Units -
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
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, CW Code.)
Side Setback from Property Line +'
Lender's Nam
I . . , -
Lender's Address
Estimated Valuation
r
INSPECTOR
This is a buildi ng permit when ptoperty filled out, signed and validated, and is subject to
PERMIT
AMOUNT
Plan Chk. Dep.
s-5"89 '
application and state that the above information is correct
1
Plan Chk. Bal.
Date Permit
87. 75 '
Const.
M.00
Mech.
27.00
Electrical
3100.00 '
Plumbing
24X0
S.M.I.
'•. -
City,. State, Zip
Grading
Driveway Enc.
Infrastructure
4
�
TOTAL
a
r %r
REMARKS
-
diiJ.i .I a;u<.w+sre a.+,..v_eaa a.s,r ,x•....-- t.• :,rs- .
a —_Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE:
BY: - -
subject to the Workers' Congwisation provisions of the Labor Code, you must forthwith
comply with such proymmomorUnpermit shall bedeemed 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, CW Code.)
Side Setback from Property Line +'
Lender's Nam
I . . , -
Lender's Address
FINAL DATE
r
INSPECTOR
This is a buildi ng permit when ptoperty filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that 1 have nod this
s-5"89 '
application and state that the above information is correct
1
Issued by:
Date Permit
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 inspectiompurposes
Validated by:
Signature of applicant Date' '
Mailing Address
Validation:
'•. -
City,. State, Zip
-
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB. if
BONDING
YARD SPKLR SYSTEM
2ND FL SQ. FT. ®
FORMS
SEWER OR SEP `IC TANK
ROUGH WIRING.
SVC.
BAR SINK
POR. SQ. FT. @MOBILEHOME
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SQ FT ®
FRAMING
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
r/ c
Ile
WATER PIPING
NOTE: Not to be used as property tax valuation
REMARKS:
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTOHDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
SPARK ARRESTOR
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TE MIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
INSULATION/SOUND
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3Vic
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 PLUMBkNUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. if
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEP `IC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER 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
r/ c
Ile
P
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNAT°JRESIINITIALS
GARDEN WALL FINAL
t