15258 (RPL)P.O. BOX 1504 N o . 15-258
Building��%-''i85i��,�� 78-495 CALLE TAMPICO .
Address LA QUINTA, CALIFORNIA 92253
Center HomesiWilaon
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description Pool
OCC: GRP.
`
& Sna
Ma?1.
ling"
Address . -1535 S. St.
Crty
San` �3>; rnad�}It>D
Zip
, J2.4t#
Tel..
415 .3il w6t107
r Contractor
Dodson Pools
Address
68-505 A Perez Rd.' E9
CG&Qherdsal. Cit .
Zip9223'4
Te1.:324-1232.
State Lid.,
& Classif.'. 574127
City
Lic. # 1044
Sq. Ft. No.
No. Dw.
Size Stories
t
Units
Arch.; Engr., .
Designer
New ❑ Add ❑ Alter ❑
Repair ❑ : Demolition ❑
1 Address
Tel.
..
City
Zip
State.
Lic. #
' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that) am lieensed�der provisions of Chapter 9 (commencing with Section
r7000) of Division 3 of the Busine and Professions Code, and my license is in full force and
effect: rd.,•'yyq 0i7
SIGNATURE i % DATE
1 ,OWNER BUILDER DECLARATION
I hereby affirm that Ilam exempt from the Contractor's License Law for the following
Estimated Valuation
��
.reason: (Sec. 7031.5,Bustness 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 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 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 sale. If, however, the building
or improvement is sold'wllhm 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.)
s,�
-
PERMIT,-
-• ° '
AMOUNT
Plan Chk. Dep.
-
Plan Chk. Bal.
-'� - U �-
Const.
$ • 00
Mech.
.200
�-
Electrical
Plumbing
_
s-
❑ 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
{loos not apply to an owner of property* who builds or improves thereon, and who contracts for
such projects with a contractors) jicensed pursuant to the Contractor's License Law.) -
❑ Lam. exempt under Sec B. & P.C. for this reason
. •
S.M.I.
Grading
Driveway Enc.
Dateowner
Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby alQrm that I have a certificate of consent to self -insure, or a certificate of
Worker's Cot�pensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Poli y Noor%' Company
1(3 py is filed with the city; . .O Certified copy is hereby furnished.
TOTAL
•
' CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
-
(This secdor need not.be completed If the permit is for one hundred dollars ($100) valuation
' or less.)
I certify that in the performance of thq 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. g, 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.
ZONE: BY:
Minimum Setback Distances:
-
-
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 it work thereunder is suspended for 180 days. -
1 car tifythat 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
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
Validat
. 1. Validat
•L
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. S0. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT.
ROCKSTORAGE
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN
SO. FT. ®
OTHER APPJEOUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
-
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
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
FINAL INSP.
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 I
IBATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1+/o c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ic
HOUSE SEWER
SPARK ARRESTOR
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 & AIR COND. SOLAR
SETBACK
GROUND PLUMBIN
^ /� �Y
UNDERGROUND
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.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
)
-
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
J
y/��
REMARKS:
VENTILATION/;�!/��/�'✓�
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION QI `
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
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