14614 (RPL)P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 79"685 Star Flower =1r. LA QUINTA, CALIFORNIA 92253
Owner Judy Rowley
Mailing
Address nS. t" MiS
City7CA.
ip
La Quinta.; 92253
Contractor
Tiro Silbert Inc.
Address
39685 5t. 141chael Place
Purim Desert, Ciklp 92211 Tel
State Lic. City
& Classif. A 617723 Lic. #
Arch., Engr:,
Designer
Address Tel.
City Zip State
Lic. #
tLICENSED CONTRACTOR'S DECLARATION
'hereby affirm that -I -am licensed under.pro iv sions of,Chapte'r 9 (commencing with Section
7000) of;Division`3 of the Business and,Piofessio s Code, and my license is in full force and
- ffei �'_ : Cis!' fr * �
GNATURE +•,� !� �• t DATE
f� OWNER -BUILDER DECLARATION .
I hereby�tiffinn,that 1 am exempt from the Contractor's License Law for the following
� reason: (Sec.. 7034.5,Business and Professions Code: Any city or, county which requires a
.—p�rmlt to construct, atter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 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 of 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 dM not build or improve 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) (lcensed pursuant to the Contractor's License Law.) -
❑ 1 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, or a certificate of
Worker's Co1r 1pensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy�o� .Company
@9 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 one hundred dollars ($100) valuation
or less:)
1 certify that in the performance of the work for which this permit is issued, I shall not
'employ any prson in any manner so as to become subject to the Workers'. Compensation
Laws of Cal ifeornia.
Date Owner
NOTICE TO APPLICANT: d, 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 this 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 OF COMPENSATION,
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 180 days. .
1 certify that I have read this application and state that the above information is correct.
l 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.14614.
BUILDING: TYPE CONST. OCC. GRP.
Number
Legal Description
Project Description Pool and Spa
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ • Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation*
PERMIT AMOUNT
Plan Chk. Dep. .
Plan Chk. Bal. 64.35
Const. 99.00
Mech. 24.00
Electrical 45.00
Plumbing 27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure _
a w r
amt: Lir1u, � 11K3�4ii7 i.i3fc:.16E Y.
r ��O
TOTAL alts
REMARKS —3. ...�i.5.......
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. 1 e
Side Street Setback from, e r Line
Side Setback from Prgp y Line
FINAL DATE INSPkCTOR
Issued by: Date Permit
Validated by: 9`9 /
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. @ $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
STORAGE TANK
FORMS
SEWER OR SEPTIC ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
FOUND. REINF.
GAS (ROUGH) METER LOOP
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
REINF. STEEL
GAS (FINAL) TEMP. POLE
DRAINAGE PIPING
CAR P. SO. FT. @
GROUT
WALL SO. FT. @
DRINKING FOUNTAIN
SO. FT. @
BOND BEAM
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GRADING .
cu. yd.
$ plus x$
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
VENTILATION
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.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1% c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
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 f' 1 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 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.
F
V
FRAMING
FINAL INSP.
ROOFING
//17ftXt 90
aye--
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Cv
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURE9INITIALS
GARDEN WALL FINAL
I/V
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