15830 (RPL).' P.O. BOX 1504
Building 7$«76 Spyglass 'till Dr. 78-495 CALLE TAMPICO
. �� _ 1 A rll IIIdTA Cel UW)AMIA.09953
Owner Smoley r David
Mailing
Address Same as above
City t - Zip Tel.
"�r� ;Quinta 92253 5564-'6467
contrar.. California Pools and Spas
41.--910 Boardwalk _..-2
City Zip Tel.:
1m Desert 9221.1 340-9000
r
`._;.•State Lic.City
&_Classif. 656 2$ Lic. # 355
Arch., Engr.,
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. 703 1.5, 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 file 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 rove hundred dollars ($500).
❑.l, 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 bnprove 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 propertywhobuilds or Improves thereon, and who contracts for
such projects with a contractors) ffcensed pursuant to the Contractor's License Law.)
O 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy Is filed with the city, O Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(This section need not be completed if the permit Is for one hundred dollars (8100_), 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.
Date_LOwner
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.
er
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,()00), 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.
I certify that I have, read this application and state that the above'informalion.is coriect.
I agree to comply with all city and county ordinances and state laws relating to building
conslructlon, and. hereby 'authorize representatives -of this city to- enter the.. above-.
mentioned propertyrfor inspection purposes. ,
Signature of applicant Date
Mailing Address
City, State, Zip
No. 15830
LDING: TYPE CONST. OCC: GRP. _-
A.P. Number
Legal Description
Project Description Pel a Spa.
Sq. Ft.
Size - ,'
No.: No. Dw. r
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ :Demolition ❑
Estimated. Valuation
$90700.00
I
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. '
41� ''76.05
Const..
*117 a 00
Mech.
!V24.00
Electrical
45. -00-
Plumbing
2-1.00
S.M.I. _
r
Grading
Driveway Enc.
Infrastructure
TOTAL .
289.05
REMARKS
ZONE: BY: r
Minimum Setback'Distances: W t
Front Setback from.Center Line `
Rear Setback from Rear Prop. Line -
Side Street Setbackfrom Center Line '
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
.Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. ® $
UNITS
A.C. UNIT
2ND FL. SD. FT.
SLAB GRADE
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
STORAGE TANK
FORMS
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DUCT WORK
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (ROUGH)
METER LOOP
WALL SO. FT.
DRINKING FOUNTAIN,
SO. FT. ®
REINF. STEEL
URINAL
TEMP. POLE
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
SERVICE
FLOOR DRAIN f
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING
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
SPARK ARRESTOR
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
ROCKSTORAGE
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIfZ % 17
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL