15118 (RPL)P.O. BOX 1504
BuildinAddrress `fig -725 AVE Jam. JARI'tA LA OUINTA, CALIFORNIA 92253
Owner GILL EIT STEINER
Mailing
Address . SA
City LO Zip922c3 Tel.
L;ontractor VMSTE N : POOH
Address 43-305 XMISON ST
city. INDIO ZiP92201
State Lic. 34,876a C53
& Classif. .
Arch., Engr.,
Designer
Tel.347—
No. 15118.
LDING: TYPE CONST. OCC: GRP.
P. Number
Legal Description
Project Description
POOL € NL)C
L;Ity IX151
Lic. # Sq. Ft. No. No. Dw.
Size Stories _ Units
New ❑ Add ❑ . Alter ❑ Repair ❑ Demolition ❑
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 Divisio:3,o h Bus i d Professions Code, and my license is in fu I orce and
..effect. •,/! • �;,r �
SIGNATURE l✓�" DATE
'
OWNER -BUILDER DECLARATION/ Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,ausiness and Professions Code:. Any city or county which requires 'a 9500.00
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 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 exempt therefrom, and, the basis•- - i.
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan'Chk. Dep. S.:.Q9
subjects the applicant to a civil penafty of not more than five hundred dollars ($500). Plan ChkBBI
❑ I, as owner of the property, or my employees with wages as their sole compensation, will . . F1 / r 0 5
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const.Professions Code: The Contractor's Ucense -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,- Mech.>,, ��
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 Electrical��
of proving that he did hot build or improve for. the purpose of sale.) •
O 1, 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 contractors) ficensed pursuant to the Contractor's License Law.) -
Grading
❑ 1 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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL L289A5
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 thg 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: d, 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 of this permit shall be deemed revolted. _ Minimum Setback Distances: -
Front Setback from Center Line
Rear Setback from Rear Prop. Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ANDSide Stfeet Setback from ' Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100•!X10), IN ADDITION TO THE COST OF COMPENSATION, Side Setback from Prop ine
DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND /'
ATTORNEY'S FEES. a
'This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE - INSPE R
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date`m�
I agree to comply with all city and county ordinances and.state laws. -relating to building it (�
construction, and hereby authorize representatives -of this city to' enter- the above.. / [ 7
mentioned property for inspection purposes. Validated by: �y ! f L /
Signature of applicant Date \
Mailing, Address Validation: i
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUM9IZ EES'% T
1ST FL. SO. FT.® $
UNITS
A.C. UNIT
2N0 FL. SO. FT. ®
"
YARD SPKLR SYSTEM
POR: SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
SEWER OR SEPTIC TANK ROUGH.WIRING
DRAINAGE PIPING
WALL SQ. FT.
ROCKSTORAGE
DRINKING FOUNTAIN.
SQ. FT. ®
GAS (ROUGH)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
HEATING (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
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
LAUNDRY TRAY
AIR HANDLING UNIT CFM
WATER SYSTEM,
FINAL INSP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID'® 11/4 c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FIREPLACE
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMIFEE-1 PLUMB. FEE
STRUCTURE PLUMBING . ELECTRICAL HEATING B AIR COND. SOLAR -
SETBACK
GROUND PLUMBI
LOQ 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 APP./EQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION 9
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL
MCK P/t.
Pomp
_ �Wfi
Uc. # , , .
348768
1047 43 375 Madison St. Indio, CA 92201
0
(61.9) 347-5959