15484 (RPL)P.O. BOX 1504
Building r 78-495-CALLE TAMPICO
Address 47-810 Via Firenze LA OUINTA, CALIFORNIA 92253
-Ownercen-t ry Homes
Mailing
Address 3535 South OD" SSS..
City - Zip Tel.
Sarn Bernerldi n ,,.CA 924081(909)381-6007
Contractor.
'.I�a�d sons Pools
Address
.68-805 A Perez Rd. E-9
CL'yathe'l rr31 C t1 Ftp CA 92234 Tel324--1232
State Lic. City
& Classif.. 5743,27 Lic. # 1044
Arch:, Engr.,
Designer
Address Tel.
LDING: TYPE CONST
Number
No. 1.5484
OCC: GRP.
Legal Description
Project Description 1'O°` and Spa
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Date Owner
NOTICE TO APPLICANT. ff, 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.
Ttiis 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
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
ZONE:
BY: '
Minimum Setback
Distances:
City
Zip
State
Side Street Setback from Center Line
Lic. #
Side Setbac�m'Property�Line
INSPEC O'R`
LICENSED CONTRACTOR'S DECLARATION
V
Issued by:
I hereby afhrm,that I am licensed under provisions of Chapter 9,(c`ommencieg with Section
Validated by:
2
efflot Dpivision'3 of the Business and Professions,Code, and y license is in`full force and
�,.r��
Validation:\
SIGNATUHLf- , -- - "`^""� DATE
-
t+ OWNER -BUILDER DECLARATION
I hereby I from License Law for following
Estimated Valuation $12,200.00
_-
affirm that am exempt the Contractor's the
•' reason: (Sec. 7031.5,Susiness 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
• A;quires the applicant for such permit to file a signed statement that he is licensed pursuant to
PERMIT
AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing, with Section 7000) of
-
,,,- Division 3 or the Business and Professions Code, or that. he is exempt therefrom, and the basis
'" for the, Any Section 7031.5 by 'any for
- -
Plan Chk. Dep.
alleged exemption. violation of applicant a permit
A" subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
—
Plan Chk. Bal.
93.60 '
❑ I, as owner of the property, or my employees with wages as their sole compensalior4 will
do the work, and the structure is not intended or offered for sale. (Sec.- 7044, Buisness and
Const.
144-00,
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,
Mech.
!` 0
provided that such improvements are not intended or offered for sale. If, however, the building
.24',
- or improvement is sold within one year of completion, the owner -builder will have the burden
Electrical-,
of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
27.00
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
S.M.I.
such projects with a contractor(s) (lcensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. - B. 8 P.C. for this reason
�••'•
Driveway Enc.
Date Owner e-# rfra ..v� i Y.s--
Infrastructure
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. I Company
❑ Copy is filed with the city. ❑ Certified Copy is hereby furnished.
TOTAL
333.60
CERTIFICATE OF EXEMPTION FROM
REMARKS
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 thg work for which this permit is issued, I shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of Galnfornia.
Date Owner
NOTICE TO APPLICANT. ff, 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.
Ttiis 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
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
ZONE:
BY: '
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from,Rear Prop. Line•
Side Street Setback from Center Line
Side Setbac�m'Property�Line
INSPEC O'R`
FINAL DATE
V
Issued by:
Date Permit\
Validated by:
2
Validation:\
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SQ. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN
SQ. FT. ®
HEATING (FINAL)
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
GRADING
cu. yd.
$ plus x$
LAUNDRYTRAY
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/<c
HOUSE SEWER
SPARK ARRESTOR
GAS PIPING
PERMIT FEE
MIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE EPL.CK.FEE
CONST. FEE ELECT: FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING . ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUM ''
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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) Q /�
U
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
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
Maowor
REMARKS:
VENTILATION
�S/r8l�s ��tiSirlas*J
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION s
VV
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL