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15749 (RPL)414 Qgb(& f3 P.O. BOX 1504 No. 15749 Building 78-495 CALLE TAMPICO Address 44-060 Goldenrod Cir LA QUINTA, CALIFORNIA 92253 - Owner - Jason Altman Mailing BUILDING: TYPE CONST. OCC. GRP. Address Same as above A.P. Number City ba Quinta Zip 92253 Tel. , Legal Description ContractorTherieanConstruction Project Description Pool Spa A rirl rPS - 4741 C.E. Palm Canyon Dr 1115 Patz Springs -92264 778-y3939 State Ljc. City 3531035 Lio # 254 & Classif. . Arch., Engr., Designer Address Tel. City (Zip (State Lic. # I herebyy;"ffirm that,l`am'licerised under provisions bhChapter 9 DDO) of vision 3 of the Business and Professions Code. and.m, OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Susiness 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 Code, or thathe 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 s civil penaltyof not more than rive hundred dollars ($500). 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 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 WHO or knprove for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to torr 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) licensed pursuant to the Contractor's License Law.) ❑ 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 Me permit is for one hundred dollars ($100) valuation or less.) �rr I certify that in the performs ce gffhg work for whlc his permit is issued, I shall not employ any,��pperrsggn in any magner s6 as to becorn dutilect to the Workers' Compensation Laws obCalifornri /.d_ dr WOTICE TO APPLICANT: '.dJ'after making this Certificate of Exemption you should be -"come subject to the WorkerSbompensadon 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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. 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 Address City, state, zip Sq. Ft. No. No. Dw. Size - Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $14,000.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. • Const Mech. �' 4 • V'0 Electrical 45.00 Plumbing • 00 S.M.I. Grading Driveway Enc. Infrastructure TOTAL '' '� °� `� • `� REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: SEP 12 1995 By _ 6 CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINiU FEES IST FL. SO. FT. ® $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER OR SEPTIC K ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SO. FT. GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN SO. FT. ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ =$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES ROOFING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER 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, 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 ® I'A c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FINISH GRADING FINAL INSPECTION CERT. OCC. 11 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 A� ELECTRICAL I HEATING & AIR COND. SOLAR li'� �cdt SETBACK GROUND PLUMBING UNDERGROUND t A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC K ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. 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 / 111 �/l� t�/ /✓✓��y REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPAR iIRRESTOR \ GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. 11 FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL C I TY O F LA QU 11 NTA -;tractor/�i;,;;;w ��CJ ,-1z,j/6_ Address ;�.c.� owner ��y,-�� Job Address J-yl v,�-y9�7L- This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub-contractors that are on this list are the same persons performing the work. Any changes of this list must be approved by the City of La Quinta Department of Building and Safety rior to work being performed by a changed sub-contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit. TRADE SUB-CONTRACTOR NAME CONTRACTOR'S WORKMAN COMP. CITY BUSINESS LICENSE NO. NO. ON FIL LICENSE NO. GRADE/ V 0 11,R Ac, EXCAVATE �►' PIPELINES ' CEMENT/ FOUNDATIONS j�Y� k� y72/�-7 17 y�.n CEMENT/WALKS 4�� c �I' •v��it`�Tc'r & DRIVES � V `�� / h (o `Jam! z - ��2jl� ASPHALT FRAMING STEEL/ STRUCTURAL MASONRY PLUMBING LATHING DRYWALL PLASTERING C HVAC ELECTRICAL 411,14,7T.0f0/1&- ROOFING SHEET METAL FLOORS GLASS/ j GLAZING INSULATION SEWAGE DISP PAINTING/ DECORATING TILE 1-4'77 P-0- clu J'4 CABINETS/ INSTALLATION ORNAMENTAL METAL FENCES/ BLOCK WALLS LANDSCAPING OTHERS GATTU50 POOL INC. PAGE D1 09/01/1995 12:37 619-77E-4920. XF i POOL AREA TO 'BE ENCLO 'ED BY O ' MINI UM 5 FT. P?IGH FENCE. ES TO BE -SELF-CLOSING /Cv �i _ ELF -LATCHING. CITY, UITA 41 BUILDING & S IsETY DEPARTMENT CON�T90u A.m" ACCEPTED C,C!,1STRUCMN SU ECZTO j _-A- N AS PE.R ISD 9LE CIDDES DATE 6Y