13340 (RPL)I •y � � � I • 7�/I
P.O. BOX 1504
Building 51--675 Ave. Herrera 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner ane .'MOOR
W
Mailing Same
Address
City Zip Tel.
La QUinta, CA 922.53.
Contractor
Western Pools
P.O. Box 1447
Clitldio, CA zip 92241 Tel347-5959
State Lic.C53 348768 City 1151
& Classif. Lic. #
Arch., Engr.,
Designer
Address Tel.
I City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
!.hereby affirm that I amlicensed under provisions of Chapter 9 (commencing with Section
�7
000) of Division 3 of ria, u~'Iness aCd4p fessions Code, and my license is in full force and
.eftect.
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
j, reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
i 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) o/
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 live hundred dollars ($500).
O 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 o/ 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. It, however, the building
or improvement is sold within one year o/ completion, the owner -builder will have the burden
o/ 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) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
i
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
OtCopy is filed with the city. O 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. -
I
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
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.
1 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
No.
BUILDING: TYPE CONST. OCC. GRP.:
A.P. Number
Legal Description
Project Description Pool no heater
13340
FINAL DATE
f
Issued by: Date_
Validated by:
Validation:
__7Jd
Sq. Ft.
Size .
No. No. Dw.
Stories' Units
New O Add'o
Alter ❑ Repair ❑
Demolition ❑
Estimated Valuation
$10,500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
81.. 90
Const.
126. ou
Mech.
24.00
Electrical
45.40
Plumbing
27.40
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
303. U
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street SetbaFF'k-fro.,Center Line
Side Setback frorhfjj?operty/l i
FINAL DATE
f
Issued by: Date_
Validated by:
Validation:
__7Jd
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FFICS
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
1ST FL. SO. FT. ® $
UNITS
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
I
DUCT WORK
Y
ARD SPKLR SYSTEM
2ND FL. SO. FT. Q
GAS (ROUGH) METER LOOP
i EATING (FINAL)
OTHER APPJEGUIP.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GROUT
GAR. SO. FT. ®
POWER OUTLET I
ROOF DRAINS
BOND BEAM
WATER SYSTEM
FINAL INSP. [ —�
—� (
FINAL INSP.
DRAINAGE PIPING
CAR P. S0. FT.
LUMBER GR.
FRAMING
WALL SO. FT.
��e
DRINKING FOUNTAIN
SO. FT.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
I
WATER PIPING
NOTE: Not to be used as property tax valuation
I
FLOOR DRAIN
MECHANICAL FEES
I
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN I
WASHER(AUTO)(DISH)
APPLIANCE . . ' DRYEA
I
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
I
LAUNDRY TRAY
AIR HANDLING UNIT CFM
I
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC I
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM I
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT I
SHOWER
BOILER B.T.U.
SO. FT. ® c I
BATH TUB
SO. FT. ® c I
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c I
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac I
HOUSE SEWER
INSPECTOR'S SIGNATURESIINITIALS
GAS PIPING
PERMIT FEE
PERMIT FEE I
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELIECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN —7 UNDERGROUND T '7�(l
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
I
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING
I
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
i EATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
I
ANAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. [ —�
—� (
FINAL INSP.
TRADING
cu. yd.
$ I plus x$
i
_$
LUMBER GR.
FRAMING
ROOFING
��e
REMARKS:
VENTILATION
FIRE ZONE ROOFING!/)
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION L '%L7�/(/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
n:
s/Az- ///-
Pool
Equip
Uc. # p
348768 W-
P.O. Box 1047 43 375 Madison St Indio, CA 92201
(619) 347-5959
POOL AREA To BE ENCLOSED By
MINIMUM 5 FT. HIGH FENCE.
ALL 'GATES TO BE SELF-CLOSING
AND SEL F*--LATCH.ING.
CITY 0)
F) Q1k_flNTA
BULDIN"I'_3, C_*SJ1i
IR k_N
1-10
AND ALL APPLICABLt CC}DE���
DATE
Alike S� 00
675' 111-el-rera,
OVA t, C14.
U5A 7 3 5 -5-39