15577 (RPL)Building
Address 78--8$5 LiMa
Owner
Wayne Simmons
Mailing
Address sBID,t;: as above
City
Contractor
California Foals
- Address
1-910 Boardwalk
city
Palm Desert. Zi92260
State Lic.
&Classif., 656.17$
Arch., Engr.,
Designer k
Address
I hared
D001 of
44
P.O. BOX 1504 No. 15577
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
7
Tel.
nit Spa -A
Stzi te A-3
Tel.:
340-,,9400
City '
Lic. # 355
Tel.
Zip State
Lic.'#
,,CONTRACTOR'S DECLARATION
under provisions of Chapter 9 (commencing with Section
and Professions Code, and my license is.in full force and
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 file a signed statement that he is licensed pursuant to
the provisions of the Contiactor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, 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).
❑ 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 safe. 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 'approve 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 contractors) Qcensed 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 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
6ECopy is filed with the city. ❑ Certified copy, is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need *not be completed ff the permit is for one hundred dollars (x160). 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: d, 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 if 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
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
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description P001 and Spa
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New.® Add ❑
Alter ❑
Repair ❑ Demolition ❑ '
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:
A n
n
t 1i
Estimated Valuation
$1,01000.00
,
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
76-05
Const.
117.00
Mech.
24
Electrical
45,00
Plumbing
97 .1110
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
R _
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:
A n
n
t 1i
Validation:
I
,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINii FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SO. FT.
AS (ROUGH)e?//,? (
L /
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEGUIP.
DRINKING FOUNTAIN
SO. FT. ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
,FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
c
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 B AIR COND. SOLAR
SETBACK
GROUND PLUMBI
UNDERGROUND ,L
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
'HEATING (ROUGH)
STORAGE TANK
.FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
AS (ROUGH)e?//,? (
L /
METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
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
/
G U
c
REMARKS:
VENTILATION"
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION/,/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL