9413 (RPL)r e
t
P.O. BOX 1504
Address 52-307 VALLEJO LA QUINTA CAL FORNIA 92253
Owner
MICHAEL A. FISCHER
Mailing
Address 2240 YUMA WAY
City Zip F7i4-
PULLBRTONs CA92635
Contractor
FAME
Address
SME
City lZip Tel.:
State Lic. I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
CityI Zip I 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
TWO'
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Susiness and Professions Code: Any city or county which requires a
permit to construct, atter, 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 or not more than five hundred dollars ($500).
0 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.)
LV(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) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
„Date �� �1 Owner f /.��•r'lt�` �7 /e to ,
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
WO R KERS' 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 thg work for which this permit is issued, 1 shall not
employ any person in any manner so as,to become sutiject,to the`WorkersfCompensation
Laws of California. t }� ri f� w� �r
�* Date ' f - t. V1 Owner /r > 'e. 11Ir 1 I.r
NOTICE TO APPLICANT: It, after making'this 'Certificate -of Exemption you should become
subject to the Worksis' Compensation provisions of the Labor Cade, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
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 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. 9433
BUILDING: TYPE CONST.
,A.P. Number
Legal Description 151 R 301 '
Project Description
OCC: GRP.
POOL AND SPA
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New.M Add ❑ Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$ 8.500
PERMIT
AMOUNT.
Plan Chk. Dep.
Plan Chk. Bal.
$70.OU
Const.
24.00
Mech.
45.00
Electrical
27.00
Plumbing
.63
S.M.I.
Grading
Driveway Enc.
Infrastructure
�tVx.� YSii,y�y6h._(,3 x4
TOTAL
V Q * U J
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
A.C. UNIT
2ND FL SQ. FT. ®
SLAB GRADE
YARD SPKLR SYSTEM
d
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
ROUGH WIRING.
DRAINAGE PIPING
WALL SQ. FT.
DUCT WORK
DRINKING FOUNTAIN.
SQ FT ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
REINF. STEEL
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SERVICE
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
WATER SYSTEM
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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 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
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
^nA ,, �,•/�'G /� /�J�,(A(�
G� /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURE31INITIALS
GARDEN WALL FINAL
ft in CALI E ESTADo
LA OUINTA. CALIFORNIA r ''
Contractor�� �L dG..ivLr? Owner Cr
Address 5-Z-,30'7 (,,iC e_c c�lo_ Job Address
k
La Quinta City License No.s Expires: Bldg. permit No.s
This form shall be posted on the job with the Building Inspection Card and it
shall be the duty of the General Contractor or if owner -Builder permit, the owner
to see that all sub -contractors sign this card, giving his City of La Quinta
Business License !lumber, Contractors License number and a current certificate
of Workman's Compensation Insurance Certificate when he starts the job-77-7—allure
to comply may cause Bui ding Inspectors to stop work, or complaints to be filed
against such contractors or owners.
CITY CONT.
SUB -CONTRACTORS NAME LIC. NO. EXPIRES LIC. NO. EXPIRES
1.
2.
3.
4.
S.
6.
7.
8.
9.
to.,
Ll.
L2.
l3.
14.
1S.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Grade i Excavate
Pipelines
Cement -Foundations
Cement Walks i Drives
Asphalt Paving
Framing
Steel Structural
Masonry
Plumbing POOL.
Lathing
Drywall
Plastering Poo!-
Stu0;-71rtD
�
HVAC
Electrical PppL
/�aiiEroiv.c�B/'
Roofing
Sheet Metal
Floors -All Types
Glass - Glazing
Insulation/Weatherstrip
Sewage Disposal
Painting/Decorating
Tile POOL -
Cabinets -Installations
Ornamental Metal
Fences/Blockwalls
Landscaping
,-/'73 CO3
Others STEEL FaI0. W6zera,-4-asp .
&UNILE' -.rte /;�'
DO NOT PJ MOVE THIS CARD
Before Final Building Inspection Will Be Made
This Form Must Be Completed and Filed With Title 24 Calcs and Plans