15052 (RPL)f _
414
P.O. BOX 1504 No. 15052
Building 78-495 CALLE TAMPICO
Address 47"515. Via Mo11' igo LA QUINTA, CALIFORNIA 92253
Owner Di] Saver
+ r
BUILDING: TYPE CONST: OCC: GRP.-
Mailing
Address 154- Falls �s,.
A.P. Number
°. City Zip Tel.
......VaLi oetertg 4A 32260 ;•' 340-3522 Legal Description '
Contractor r ;' - Poo and Spa
,�„'Project Description•'
C.�tlifok-Aia pools & :sp /
A ress
- x
Boardwalk A-2
City' Zip Te
Palm Desert, to 92e11 S'40-9000
State Lic. City
& Classif: C-53 656128 Lic. # 355 Sq. Ft. No. No. Dw.
Archl,'Engr:,
' Size .Stories .�'.• Units
' - - ,.
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic: #
�:. LICENSED CONTRACTOR'S DECLARATION
I hereby affiim that'Lam licensed under Provisions of Chapter 9 (commencing with Section
7000) of Division 3of the Business and Professions Code, and my license is in full force and
teffect. yr L xKri' t
SIGNATURE DATE -
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: -(Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a,
permit to construct, atter, improve, demolish, or repair any structure, 'prior to Its issuance -also
requires the applicant for such permit to file a signed statement thathe 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 five 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 -within one year of completion, the owner -builder will havethe burden
of proving that he did not build or knprove 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.) .
❑ 1 am exempt under Sec B. f3, P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that 1 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 140000 Company.
Viol" Is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
- 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 the work for which this permit is issued, I shall not
employ anyperson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: it, after making this* Certificate o1 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 it work I ereunder.is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
1 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
stimated Valuation $11,000.00
BY: I�
I
PERMIT
AMOUNT
Plan Chk. Dep.' s
Plan Chk. Bal.
81.90
Const. `
126.00
Mech. _
24.00
Electrical
45.00
Plumbing •
27.00
S.M.L.
Grading
Validation:
Driveway Enc.
Infrastructure
TOTAL
303.90
REMARKS
ZONE:
BY: I�
Minimum Setback Distances: nn
Front Setback frlii CeAeHLLi�e 7
Rear Setback front Rear Prop. Line
Side Street Setbaotg�om Center Line y
'
Side.Setback'from Property -Line
FINAL DATE
INSPECTOR
Issued by:'
Date Permit
Validated by:
Validation:
M,�!CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIN
1ST FL. SO. FT. ® $
UNITS
UNDERGROUND
2ND FL. S0. FT. p
COLL. AREA
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
ROUGH WIRING
DUCT WORK
DRAINAGE PIPING
CARP. SO. FT.
GAS (ROUGH) �% METER LOOP
HEATING (FINAL)
WALL SO. FT.
REINF. STEEL
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER HEATER
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
REMARKS:
LAUNDRY TRAY
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/<c
HOUSE SEWER
MESH
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
SETBACKROUND
PL
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. REINF.
GAS (ROUGH) �% METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
ROOFING
/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL