15208 (RPL)•
:4
P.O. BOX 1504 No. 15208
Building 78-495 CALLE TAMPICO
Address 52-204 Ave. Diaz LA QUINTA, CALIFORNIA 92253
Owner Miller, Cheryl
,f Mailing' _ BUILDING: TYPE CONST. OCC. GRP.
t Address P.O. Brox 596
City Zip Tel.
La Qi rota 92253
Contractor
Master Pools & Spas
Address 730555 Hw]a 112
City Zip " Tel.:
Palm Desert 92260 346-6125
State Lic. City
& Classif. C--53 238947 Lic. # 26
Arch., Engr.,
Designer
Address Tel.
City Zip State
'. ' - Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that 1 1m I1`c&sed ndet provisions of Chapter 9 (commencing witF Section
2;000) of DivWgP _3;41 tPieAG_siness And3Prgfessions Code, and my license is?in fulllforce and
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, after, 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 Cade, or that. he is exempt therefrom, and the basis
for 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 rive hundred dollars ($500).
❑ 1, 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 havetheburden
of 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-
struct the project. (Sec. 7044, Business and •Professions Code: The Contractor's License Law
does not apply to an owner or property who builds or improves thereon, and who contracts for
such projects with a contractors) (lensed 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
�Iharebalffi rmthat I have a certificate of consent to self -insure, or a certificate of
Woensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
PolCompany
py is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed H 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, ft, 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 1 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
const ru ctl on,
and hereby authorize representatives -of this city to enter - the above-.
mentioned property for inspection purposes.
Signature of applicant -Date-
.Mailing
ate.Mailing Address
City, State, Zip
P. Number
Description
It Description 18 If X 36 0 Pool Only
Sq. Ft. No. No. Dw.
Size Stories Units
Newt] Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $12,900
i
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$ 93.60
Const.
$144.00
Mech.
S 24.00
Electrical
$ 45.00
Plumbing
S 27.00
S.M.I.
Grading
Driveway Enc..
Infrastructure
TOTAL
A3 3 r,n
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front SetbackfrQNCeenter Line
Rear Setback /b Reakkerop. Line
Side Street et ck twn11,;Nnter Line
Side Set 410A rom Property, Line
FINAL DATE
Issued by:_
Validated by:
Validati
v
INSPECTOR
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
IST FL. SO. FT. @ $
UNITS
f%
A.C. UNIT
YARD SPKLR SYSTEM
2 ND FL. SO. FT. @
ROUGH PLUMB.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. @
STORAGE TANK
GAR. SO. FT. @
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DRAINAGE PIPING
CARP. SO. FT.
ROCK STORAGE
FOUND. REINF.
WALL SO. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO. FT. @
URINAL
ESTIMATED CONSTRUCTION VALUATION $
OTHER APP.IEQUIP.
WATER PIPING
NOTE: Not to be used as property tax valuation
GAS (FINAL)
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
WATER HEATER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SO. FT. RESID @ 114 c
SEWAGE DISPOSAL
REMARKS:
SO.FT.GAR @ 3/ic
HOUSE SEWER
40
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
UNDERGROUND
f%
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 APP.IEQUIP.
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
40
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION a/f1�7Jr
J
CERT. OCC.
FENCE FINAL
75r
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
BUILDING DEPARTMENT
CITY OF LA QUINTA
OFFICE: (619) 777-7012 INSPECTION REQUESTS: (619) 777-7153
TO: DATE: ��
ADDRESS:
CORRECTION NOTICE
INSPECTION: PERMIT NO.:
1141il- AZ