12696 (RPL)ceityl 4-14 "
• P.O. BOX 1504 N o . 12696 ,
BuiPding 79 955 Horseshoe 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner „
ilinsky
Mailing BUILDING: TYPE CONST. OCC: GRP.
' Address
A.P. Number
City Zip Tel.
Legal Description
Contractor Project Description Pooh, and Spa
McIntyre pools & Spas
Vass Box 2791
City Zip Tela .�
Quintal-,_ CA 92253 342-3521
State Lic. City
& Classif.�� Fi4s1 Lic. # 145 Sq. Ft. No. No. Dw.
Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Address Tel.
City
]Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that Ilam licensed uride'r provisions of Chapter 9 (commencing with Section
7000) of D'visi'o'3 ofRhe.Business and,Prolessions Code, and my license is in full force and
effect. / ' -: _VV'?J.`."p`-
ff
1GNATURE DATE
,
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation . e $12 50 +04
reason: r(Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, 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
PERMIT AMOUNT
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 exempi'therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
Plan Chk. BBI. y J. V V
❑ 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
Code: The Contractor's License
Const.Professions
144.00
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,
that'such improvements intended
Mech. 24. 00
provided are not or offered for sale. If, however, the building
or improvement Is sold within one year of completion, the owner -builder will have the burden
Electrical�II 00of
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-
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. 1.
N. such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
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 Compensattininsurance; or a certified copy thereof. (Sec. 3800, Labor Code.)
Poli�ccy,�rNo! Company
filed
O'Gopy is with the city. ❑ Certified copy is hereby furnished. - -
TOTAL 333.60
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 lhP 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: '
Front Setback from Center Line
'Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
'Side Street Setback from Center Line ' ^
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) „_-I
_ ISideSetback from Property Line
Lender's. Name—
ame
-
Lender's
Lender's Address
i
This is a building permit when properly filled out, signed and validated, and is subject to
FINAL DATE INSP C� R
expiration if work thereunder is suspended forj180 days. r`
.7
I ceitify that I have read this application and state that the above information is correct.
Issued by: Date Permit
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.
Validated by: iJAN 2 4 g. 4
v
Signature of applicant Date
MailingAddress
Validation: ti
City, State, Zip
Y
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
(
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
HEATING (ROUGH)
STORAGE TANK
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
GAS (ROUGH)
DRAINAGE PIPING
CARP. SQ. FT.
HEATING (FINAL)
OTHER APPJEQUIP.
_WALL SQ. FT.
GAS (FINAL)
DRINKING FOUNTAIN.
SQ. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE .UNIT . WALL FLOOR SUSPENDED
FINAL INSP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ. FT. RESID ® 11/4 C
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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
6 /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL