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15266 (RPL)0 Building P.O. BOX 1504 79"325 Desert Stream LA QUINTA, CALIFORNIA 92253 vvvner Lacy Mailing Address Same City ' .a Quiuta, CA Zip 92253 Tel. Aqua Quest Pools Address P.G. Pox 11206 IF91m Desert, C i"' 92255 345-•5070 State Lic.C_r�3 476807 City 130 & Classif. Lic. # Arch., Engr., Designer Address Tel. CityI Zip I 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,Suslness 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 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 lot the 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 five hundred dollars (E500). ❑ 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, Suisness 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 inprove for the purpose of sale.) O I, as owner of the property, am exclusively contracting with licensed contractors to con - Strutt 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) licensed 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. Company O 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 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: If, 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. 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 it 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 ateMailing Address City, State, Zip A No. 15266 LDING: TYPE CONST. OCC. GRP. P. Number Description Pool and Spa ZONE: BY: Minimum Setback Distances: Front Setback from Center 4tne Rear Setback from Rear Prop, Ltinne Side Street Setback I �n er U.ne Side Setback fromy Li e FINAL DATE ' -f SPECT,_R Issued by: DatePerrrtit l� Validated by: 1- Sq. Ft. Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ L Estimated Valuation $1,500.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 10.5 • . Const. 1b2. Mech. • Electrical 45.UO Plumbing 27 . S.M.I. Grading Driveway Enc. Infrastructure TOTAL 4 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center 4tne Rear Setback from Rear Prop, Ltinne Side Street Setback I �n er U.ne Side Setback fromy Li e FINAL DATE ' -f SPECT,_R Issued by: DatePerrrtit l� Validated by: 1- n TOTAL FEES STRUCTURE SETBACK SLAB GRADE FORMS FOUND. REINF. REINF. STEEL GROUT BOND BEAM LUMBER GR. FRAMING ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL GARDEN WALL FINAL MICRO FEE PLUMBING GROUND PLUMBIN ROUGH PLUMB. SEWER OR SEPTIC GAS (ROUGH) GAS (FINAL) WATER HEATER WATER SYSTEM FINAL INSP. NO. ELECTRICAL FEES UNITS MOBILEHOME SVC. POWER OUTLET SIGN NO. PLUMBIWU FEcS >d YARD SPKLR SYSTEM 1 BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING FLOOR DRAIN WATER SOFTENER WASHER(AUTO)(DISH) GARBAGE DISPOSAL LAUNDRY TRAY KITCHEN SINK TEMP USE PERMIT SVC WATER CLOSET' POLE, TEM/PERM LAVATORY AMPERES SERV ENT SHOWER SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER SO. FT. RESID ® 11A c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE ELECTRICAL HEATING 6 AIR COND. SOLAR G I UNDERGROUND A.C. UNIT COLL. AREA BONDING HEATING (ROUGH) STORAGE TANK TA ROUGH WIRING DUCT WORK ROCK STORAGE METER LOOP HEATING (FINAL) OTHER APPJEOUIP. TEMP. POLE SERVICE FINAL INSP. GRADING FINAL INSP. cu. yd. $ plus x$ =$ REMARKS: 7 iT 41 I_ V \ CONSTRUCTION ESTIMATE i IST FL. SO. FT. ® $ 2ND FL. SO. FT. p POR. SO. FT. GAR. SO. FT. CAR P. I SO. FT. WALL SO. FT. SO. FT. ESTIMATED CONSTRUCTION VALUATION $ NOTE: Not to be used as property tax valuation MECHANICAL FEES VENT SYSTEM FAN EVAP.COOL HOOD APPLIANCE DRYER FURNACE UNIT WALL FLOOR SUSPENDED AIR HANDLING UNIT CFM ABSORPTION SYSTEM B.T.U. COMPRESSOR HP HEATING SYSTEM FORCED GRAVITY BOILER B.T.U. MAX. HEATER OUTPUT, B.T.U. n TOTAL FEES STRUCTURE SETBACK SLAB GRADE FORMS FOUND. REINF. REINF. STEEL GROUT BOND BEAM LUMBER GR. FRAMING ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL GARDEN WALL FINAL MICRO FEE PLUMBING GROUND PLUMBIN ROUGH PLUMB. SEWER OR SEPTIC GAS (ROUGH) GAS (FINAL) WATER HEATER WATER SYSTEM FINAL INSP. NO. ELECTRICAL FEES UNITS MOBILEHOME SVC. POWER OUTLET SIGN NO. PLUMBIWU FEcS >d YARD SPKLR SYSTEM 1 BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING FLOOR DRAIN WATER SOFTENER WASHER(AUTO)(DISH) GARBAGE DISPOSAL LAUNDRY TRAY KITCHEN SINK TEMP USE PERMIT SVC WATER CLOSET' POLE, TEM/PERM LAVATORY AMPERES SERV ENT SHOWER SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER SO. FT. RESID ® 11A c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE ELECTRICAL HEATING 6 AIR COND. SOLAR G I UNDERGROUND A.C. UNIT COLL. AREA BONDING HEATING (ROUGH) STORAGE TANK TA ROUGH WIRING DUCT WORK ROCK STORAGE METER LOOP HEATING (FINAL) OTHER APPJEOUIP. TEMP. POLE SERVICE FINAL INSP. GRADING FINAL INSP. cu. yd. $ plus x$ =$ REMARKS: 7 iT 41 I_ V \ r V ❑ ? -• y y Y /1 �X YV 'vim[ sG�LL I 3,•3• Via. 3, -tS w / kit O LlceavJ -� i- » s QUINTA T'6'BUILDING & SAFETY'DEPARTMENTGONDmemAtuf Li �f ACCEPTED FOR CONST RUCT'ON SUBJECT TO INSTALLATION AS PER i T S T•' P� J AND ALL APPLICABLE C D S l L,3 E ENCLOSED BY ATE g I -- �;......__• , _ IGH FENCE. ox Palm Desert, CA M55-1206 E NGLF-CLOSING j