15324 (BLCK)Building
Address 45=21
Owner
4
P.O. BOX 1504
78-495 CALLE TAMPICO
DESERT FOX LA QUINTA, CALIFORNIA 92253
Mailing
Address ,SAME
City ]Zip Tel.
]LQ 92253'
~Contractor
SUNRISE POOLS
Address P.O BOX 1273
P.O 1SV2255 340-5523
State Lic. City
& Classjf. O53 556230' Lic. #16®4
Arch.,, Engr.,
Designer
Address Tel.
Ity Zip State
Lic. #
[LICENSED CONTRACTOR'S DECLARATION -
1 hereby affirm hat (gam licensed under provisions of Chapter 9 (commencing with Section
D00) of Divisiion 3 of, tie Business and.Professions Code, and my license is in full force, ad
ffec . ! f ,IA_J, . < Lcw- 4
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (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 rile 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 o/ Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O 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 contractor(s) #tensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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. 12,417 4 A Company
❑ Copy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
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
Laws of California.
employ any parson In any manner` o as toe come subject to the Workers' Compensation
Date Owner
NOTICE TO APPLICANT. lt, atter makhg'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.
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 160 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 aut�orizelrepresentatives -of this city to enter the above-.
mentioned property for inspection,puur^p]oses. C
Signature of applicant >� .� " 1-1. Date
Mailing Address
City, State, Zip
1
No. 15324
LDING: TYPE CONST. ' OCC. GRP.
P. Number
i
(Legal Description
Project Descriptions ft 4FT BLOCK WALL
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
soo.06
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. —0. 0 l
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL 30. U0
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from/Cen er Line
Rear Setback fro ar Prop. Line
Side Street Set id from ter Line
Side Setba romRro perty, , ipei/�
FINAL DATE '� INSPECTOR
Issued by: Date P'errmit
Validated by: 711111-1
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT. p
YARD SPKLR SYSTEM
BONDING
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROUGH WIRING
'DUCT WORK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
GAS (ROUGH)
METER LOOP
DRAINAGE PIPING
CAR P. I SQ. FT.
REINF. STEEL
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
NOTE: Not to be used as property tax valuation
BOND BEAM
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
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.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
En
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
FORMS i
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
SEWER OR SEPTIC TANK
ROUGH WIRING
'DUCT WORK
ROCK STORAGE
FOUND. REINF.IA
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURES/INITIALS
GARDEN WALL FINAL