15770 (RPL)f44 15770
' P.O. BOX 1504 No.
BuildRg78-495 CALLE TAMPICO
Add r€ss 41--99 Via Nice LA QUINTA, CALIFORNIA 92253
Owner. -Mr & Mrs i kcal
Mailing BUILDING: TYPE CONST.o OCC: GRP.
Address 47-995 Visa. NICE: A.P. Number
City Zip Tel.
Quinta 92253 564-2926 Legal Description
Contractor $uT2Xiaia PoolsProject Description Pool t Spa
Address P*0. $OX 12573
City zip -
Pala Desert 92260 340-'5521
State. Lia 556City
& 'CIassif.. 236 16 Lic. # 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 affi that am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 pf fherBusiness and Professions Code, and my license Win f41,1,for a and
effect: �k�� ��
SIGNADATE
OWNER -BUILDER DECLARATION. Estimated Valuation
I hereby affirm that 1 am exempt from the Contractor's License Law for the following �g,1 >�..!
y
reason: (Sec. 7031.5,Busmess and Processions 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 /or 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
i Division 3 o/ the Business and Professions Code, or that. he is exempt therefrom, • and the basis
for rhe alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a 'permit
subjects Plan ChkDep. - QC c�
the applicant to a civil penalty o/ not more than five hundred dollars ($500). r Plan Chk. Bal. V' .v 7 . 75
O 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 Const. ,� . �>
Professions Code: The Contractor's License Law does not apply to an owner of property who h
builds or improves thereon and who does such work himself or through his own employees, Mech.Q
provided that such improvements are not intended or offered for sale. If, however, the building
.00
or Improvement is sold within one year of completion, the owner -builder will have the burden Electrical C,
of proving that he did not build or Improve for the purpose o/sale.)
. . ` i. s
❑ 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. -
such. projects with a contractors) (fcensed pursuant to the Contractor's License Law.) _
Grading
0 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 w certificate of
Worker's Co peo In
n�?bsurance, ora certifi rc,011treof. (Sec. 3800, Labor. Code.)
PolicN
y o�: Company
DWopy is filed with the city. O Certified copy is hereby furnished.
TOTAL ti *31B. 75.
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE .
(This section need not be completed ff the permit Is for one hundred. dollars ($100) valuation
or less.)
I certify permit
that in the performance of thg work for which this is issued, I_ shall not.
employ any Parson in any manner so as to become subject to the Workers' Compensation
Laws of ca IF
Date Owner
NOTICE TO APPLICANT: ff. after making this Certificate of Exemption .you should become - ZONE: BY:
subject ro 4he Workers' Compensation provisions of the Labor code, you must forthwith Minimum Setback Distances: -
comply with such provisions or this permit shall be deemed revoked. - -
Front Setback from Center Line
Rear Setback from Re r . Line
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND Side Street Set ac a er Line
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, Side Setback f pe rty Lin
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES. - FINAL DATE INSTOR
-�
This is a building permit when property filled out, signed and validated,.and is subject to
expiration if 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: Dat Pej it
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:
Signature of applicant Date
Mailing Address - Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT. ®
POR. SO. FT. ®
GAR. S0. FT.
CAR P. SQ. FT.
WALL SQ. FT.
SQ. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
i
n
1
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
HEATING (ROUGH)
WATER SOFTENER
FORMS
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
DUCT WORK
APPLIANCE DRYER
FOUND. REINF.
GARBAGE DISPOSAL
GAS (ROUGH
FURNACE UNIT WALL FLOOR SUSPENDED
METER LOOP
LAUNDRYTRAY
OTHER APPJEQUIP.
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
GROUT
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
SERVICE
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
GRADING
cu. yd.
$ -plus-x$-=$
SQ. FT. ® c
WATER HEATER
I FINAL INSP.
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 % c
SEWAGE DISPOSAL
ROOFING
SO.FT.GAR ® 3/4c
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
FIRE ZONE ROOFING '
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE
PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER IC 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
1!5:pv�Q
GRADING
cu. yd.
$ -plus-x$-=$
LUMBER GR.
f
I FINAL INSP.
-FRAMING
FINAL INSP.
-
ROOFING
��J yr_
/
00�/1110kx/
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL