14892 (RPL)' uucv
kP.O. BOX 1504
.'Building. 78--790 Irwin Circle 78-495,CALLETAMPICO
Address LA QUINTACALIFORNIA 92253
Owner +c'r'ack Taple.shay
Mailing
Address Same
City Zip Tel.
La Quint&l CA 1 92263
F9FP'0016&
dLjss Bpx. 1126
Pad: Desfartr 92261
State Ljc. 476807-
& Classif.
Arch., Engr., -
Designer
Address
345-SO70
City
Lic. #
s 1
Tel.
No. 14892
f
BUILDING: TYPE CONST. - "OCC. GRP.
A.P. Number
Legal Description
Project Description Pool and Spa
Sq. Ft. No. No. Dw.
Size .... Stories " Units
New ❑ Add ❑ , . Alter ❑ Repair ❑ Demolition ❑
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I herebbaff rm that I am licensed_4nder provision0of Chapter 9 (commencing with Section
of ivlslon 3 of_the
)J000) pBusiness;aaP[ofessions/•Code; and my'license is in full force and
SIGNATURE DATE
'
OWNER -BUILDER DECLARATION .'
Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following
Code: Any
Cn q �q
500.00
X00
reason: (Sec.. 7031.5,Business and Professions city or county which requires a
permit to construct, after, -Improve, demolish, or repair any structure; prior to its issuance also
J V
J
- -
• requires the applicant for such permit to file a signed statement that he is licensed pursuant to
. ' •PERMIT -
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section. 7000) -of
Didsloo 3 of the Business and Professions Code, or that. he is exempt therefrom, and- the basis
for the alleged exemption. Any Section 7031.5 by 'any for
Plan' Chk. Dep.
-
violation of applicant a permit
• subjects the applicant to a civil penahy of not more than five hundred dollars ($500). -
Plan Chk. Bal.
t�
O 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
Const.
.
153.00
Professions Code: The Contractor's License Law does -not apply .to an owner or property who
builds or improves thereon and who does such work himself or through his own employees,
Mech..
2S.0
Q3
provided that such improvements are not intended or offered for .sale. If, however,. the building
,G
or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical
d� '
of proving that he did not build or knprove for the purpose of sale.)
•
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con•.
Plumbing
27.00
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
S.M.I.
such projects with a contractor(s) Pcensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B: 8 P.C. for this reason
Driveway Eno.
Date owner
Infrastructure
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 Company
*Copy is filed with the city. ❑.Certified copy is hereby furnished.
TOTAL
348.45
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 thF 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 Owner
NOTICE TO APPLICANT., If, after, making this Certificate of Exemption you should become .
- ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you. must .forthwith
comply with such provisions or this permit shall be deemed revoked.
_
- Minimum Setback Distances:
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.
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
Front Setback from Centerline
Rear Setback eck
ine
Side Street Sefirter 'ne
Side Setback fi
FINAL DATE Issued by: DatPerrr�lt}�
Validated by:`9
Validation,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
w
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P.SO. FT,
WALL SO. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
ROUGH PLUMB.
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
VENT SYSTEM FAN_ EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
DUCT WORK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR . SUSPENDED
GAS (ROUGH) -.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
HEATING (FINAL)
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
BOND'BEAM
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID @ 1'A c
SEWAGE DISPOSAL
FRAMING
ROOFING
SO.FT.GAR ® Vac
HOUSE SEWER
FIREPLACE
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 PLUMBIN
UNDERGROUN
r
A.C. UNIT
COLL. AREA
'SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTI
K
ROUGH WI NG
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) -.
METER LOOP
HEATING (FINAL)
r
OTHER"APPJEOUIP.
REINF. STEEL '
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND'BEAM
WATER SYSTEM
FINAL INS P
'FINAL INSP.
71
/
/J>
GRADING
cu. yd.
$ plus x$
REMARKS:
=$
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
A
0
-------- - g POOL AREA .TO. BE ENCLOSED BY.
Mlp.-IMHm F9 $4 -HIGH EFUCL
ALL GATES TO BE SELF-CLOSING
AND SELF -LATCHING.
CITY OF LA QUINTA
i ----� 1L�INC�SAFETv-nEPARTMENT
=x
ACCEPTED `10N�" Ly
rr� CONSTH,
�%L,
IE�T rC 1 4S i i iLLP� i �;ry S PER
R�
A.... ALL APPLICABLE ODES - -- --
�rr, DATE