05882 (RPL)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 52-70,0 Herrera LA QUINTA, CALIFORNIA 92253
Owner Jose-Dh Caminl
Mailing
BUILDING: TYPE CONST. OCC: GRP..
�_
Address S81i 1A.P..Number 773--294-012
City La Quinta I Zip 92253 Tel.
No.
Contractor
Owner/ Builder I
Address
Tela
�r
State Lic.I City
& Classif. Lic. #
Desig-W..,
ner
Address Tel.
City ZipI 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 1 am exempt from the Contractor's License Law for the following
'reason: (Sec. 7031.5.6usiness 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 pennt to fie 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 Businessard Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any vioklion of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a Civil penalty of not more than rive hundred dollars (5500).
❑ 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 Conbacfoes 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 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 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
Dateh J 7�!l e i Owner
! 'l
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
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS COMPENSATION INSURANCE
(This section need not be completed 8 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 o this permit shaft be deemed revoked.
CONSTRUCTION LENDING AGENCY
1hereby 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
Lenders Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certity 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
Legal Description
Project Description pool and spa
0 5882
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
76.05
117.00
24.OU
xlovu
.70
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 6-14-89 Permit
Validated by:
Validation:
.ECTRICAL FEES
NO. PLUMBING FEES
UNDERGROUND
A.C. UNIT
YARD SPKLR SYSTEM
SVC.
BAR SINK
T
ROOF DRAINS
HEATING (ROUGH)
DRAINAGE PIPING
FORMS
DRINKING FOUNTAIN.
TANK
URINAL
DUCT WORK
WATER PIPING
FOUND. REIN/
b
FLOOR DRAIN
WATER SOFTENER
HEATING (FINAL)
WASHER(AUTO)(DISH)
REINF. STEEL
GARBAGE DISPOSAL
LAUNDRY TRAY
KITCHEN SINK
MIT SVC
WATER CLOSET'
aM
LAVATORY
VENT
SHOWER
D c
BATH TUB
d c
WATER HEATER
11/4 c
SEWAGE DISPOSAL
V4C
HOUSE SEWER
FINAL INSP.
GAS PIPING
FINAL INSP.
PERMIT FEE
FEE ELECT. FEE
SMI FEE PLUMB. FEE
HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
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. REIN/
b
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
�
�61
7/a ,� 9 9
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