15487 (RPL)P.O. BOX 1504
Building q 78-495 CALLE TAMPICO
Address 47-965 Via Firenze LA QUINTA, CALIFORNIA 92253
OwnerCen.tUry AcaMeS
mann iy .
Address �r33J't3ULl1 oDO S$a-.
City41,
p Tel.
San Bernard. CA 924435 (909) 381-60 37
Contractor
Dodson Pools
State Lic.
& Classif. .
-Arch., Engr.,
Designer
Address
No. 15487
BUILDING: TYPE CONST: OCC: GRP.
A.P. Number
Legal Description_
a f'ooi and Spa
Project Descriptior�H
rad. Citi Zip CPQ 92.234 Te1324-3232
City
57412.7- Lic. # 1044 Sq. Ft.
Size
Tel
No.'
No. Dw.
Units
New ❑ Add ❑ . _ Alter ❑ Repair ❑ Demolition ❑
City
Zip
State
Lic. #
Side Strf
SetI
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. °
FINAL DATE
`
SIGNATURE !"-'-< DATE
!? eOWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. '703 1. 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 rile a signed statement that he is licensed pursuant to
Meprovisions 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 five hundred dollars ($500). 1
❑ 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 withinone 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
.� :2 suscp projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ I a 'exempt -under Sec. B. & P.C. for this reason
f j �,.,� ,"�-
Validated by:
Estimated VSIUatIOR
$12000.00
f
I
PERMIT
AMOUNT
Plan Chk. 'Dep. '
Plan Chk. Bal.
'- 87.75
Const.
135. 00
. Mech.
24.00
Electrical -
4;
Plumbing
27.00
-
S.M.I. .. -
Grading
Driveway Enc.
Date Ownerti
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. Company
O Copy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE -
(This section need not be completed g 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 youshould 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.
TOTAL
315.75
REMARKS
ZONE: - - BY:
� -
Minimum Setback Distances: A l �
-
_ 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-ceiffy 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
Front Se
Line
�p.�Line '
Rear Set
Side Strf
SetI
Side
FINAL DATE
Issued by:
Validated by:
..Validation:
Line
�p.�Line '
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT. p
ROUGH PLUMB.
YARD SPKLR SYSTEM
FOR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
GAS (ROUGH) ��6
DRINKING FOUNTAIN
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GAS (FINAL)
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
WATER SYSTEM
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.
SO. FT. ® c
BATH TUB
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/.c
HOUSE SEWER
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(�If
UNDERGROUND J�
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) ��6
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE /� /yOA;—,:FINAL
INSP.
BOND BEAM
WATER SYSTEM
�D/� =
FINAL INSP.
'GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
L Q�
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION /
fi,,34VV,1
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL