15738 (RPL)f
P.O. BOX 1504 No. 15738
Building 79-715 Iris Ct . 78-495 CALLE TAMPICO
Address LA QUINTA, CALIFORNIA 92253
Bob Tsmblyn
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Pool Fe Spa
Mailing SaW as above
Address
CityLa Quanta
Zip 92201
Te1347-
Contractor Western Pools
Address .
43-375 Mallilson St.
'CityZip
. Indio,
92201
Tel.:
347-5959
State Lic. 34�i�
8 Classif..
City
Lic. # 1.151
Sq- Ft.
No. No. Dw. .
Size
Stories Units
Arch., Engr.,
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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 Contractor's License Law for the following
reason: (Sec. 7031.5,Business 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
forthe 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 rive 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 or completion, the owner -builder will have the burden
of proving that he did not build or knprove for the purpose of sale.)
Estimated Valuation ,
sr
,�is a 000 00
PERMIT
AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal.
$105.30
Const.
� .00.
Mech.
h
•w24.00
�' 24 . W/�.V
Electricale
q
$ V 5 .- 0_Q
Plumbing
27.00
❑'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.)
O I am exempt under Sec B. & P.C. for this reason
S.M.1.
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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
❑ Copy Is filed with the city, ❑ Certified copy is hereby furnished.
TOTAL
$363.30
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
• (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 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 Owner
'NOTICE TO APPLICANT: ff, 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.
ZONE: BY:
;Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
Side Street Setback from Center Line
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
Side Setback from Property Line
.ATTORNEY'S FEES.
Thls is a building permit when properly filled out, signed and validated, and -is subject to
expiration if work thereunder is suspended for 180 days.
FINAL DATE
INSPECTOR >
i
• 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.
I,ssued'by: '
Validated by:
Date Permit
--- --- --
AA
Signature of applicant Date
Mailing Address
Validation:
SEP 06 199
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
1ST FL. SO. FT. @ $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SO. FT.
STORAGE TANK
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
REINF. STEEL
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN,
SO. FT. @
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
FINAL INSP.
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
LUMBER GR.
FLOOR DRAIN
MECHANICAL FEES
•�/LA
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE 'UNIT WALL FLOOR . SUSPENDED
FIRE ZONE ROOFING
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FIREPLACE
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 @ 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR @ 3/ac
HOUSE SEWER
I
GAS PIPING
PERMIT FEE
PERMIT FEE IPERMIT
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 T K ROUGH WIRIN
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
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING
ROOFING
•�/LA
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCG
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL