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15768 (RPL)r I f TA •4 i P.O. BOX 1504 No. 15768 Building r7$~740 S'ipy4lass Hill 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 Owner .dams Mailing BUILDING: TYPE CONST. OCC: GRP. Address Same as above A.P. Number 769-653-001 City Zip Tel. Lot 61 'bract 25389-1 La Qainta 92253 564-0456 Legal Description Contractor StE'.r POOPS & SpaProject Description 141 X 30' Pool a 7 ` Attached Address 73-555 HWY .1,1 City Zip Tel.: Palm Desert 92260 346-6115 Statei. Cit 238947. Licy# 16 & Classit. . Designer Address Tel. City ( Zip ( State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I 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 I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business 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 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 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 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 did 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 contractors) licensed 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 affirrn' that I have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company 0 Copy is filed with the city, ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed M 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 pperson in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT: N, 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 ADDITIOWTO 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 property filled out; signed and validated, and is subject. to expiration it work thereunder is suspended for 180 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 ateMailing Address City, State, Zip Sq. Ft. Size No. No. Dw: Stories Units New ❑ Add ❑ - Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $16,000.00 i PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. • . `J Const. 4 7R, 00 Mech."► 24i.© Electrical 45. 00 Plumbing 27.00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: J Front Setback from Cent r Line Rear Setback from Rear mop.Tlne, Side Street Setback fro ri nter L' e Side Setback from Property)ine s FINAL DATE INS ECTOR pp Issued by: Date Perrlit$ Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. 2ND FL. S0. FT. HEATING (ROUGH) YARD SPKLR SYSTEM FORMS SEWER OR SEPTIC TANK MOBILEHOME SVC. BAR SINK ROCK STORAGE POR. SO. FT. ® GAS (ROUGH)`�fiF% / METER LOOP HEATING (FINAL) GAR. SO. FT. ® POWER OUTLET ROOF DRAINS TEMP. POLE DRAINAGE PIPING WATER HEATER CAR P. SO. FT. FINAL INSP. BOND BEAM WALL S0. FT. @ DRINKING FOUNTAIN , =$ SO. FT. ® URINAL FRAMING ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING !%O ) NOTE: Not to be used as property tax valuation 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 SPARK ARRESTOR LAUNDRYTRAY AIR HANDLING UNIT CFM IKITCHEN SINK LATHING ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEMIPERM LAVATORY INSULATIONISOUND HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB AL INSPECTION 12 - SO. FT. ®c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL INSPECTOR'S SIGNATURES/INITIALS SO.FT.GAR ® 3/.c HOUSE SEWER GARDEN WALL FINAL GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEEMECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK G UND PLUMBIN— 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)`�fiF% / METER LOOP HEATING (FINAL) OTHER APP./EQUIP. 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 !%O ) REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING AL INSPECTION 12 - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL