12303 (RPL)P.O. BOX 1504 N o .
Building "(79$ 20. Vint, Helodia 78-105 CALLE ESTADO ,
Address LA QUINTA, CALIFORNIA 92253
Owner
Robed Wilson
Mailing
Address r'` .g;e.
City. Zip T -340 -4165
-La t�t'1inta.,�-CA:. �4 253
y;:_
Unique. Pools by Carmi e -
Address r '
74-818 vel e, way;;41
City Zip Te J. Pali a +a r t.. C� �` 2.250 J.46-6335
State Lic. Tom,; ti ' City
& Classif. � 51,520432 Lic. # 1366
Arch.-, Engr., •,t` -'-v
Designer
-ry
Address , Tel.
i.. I .
City ,: , r. Zip State-
Lic.
tateLIC. #
LICENSED CONTRACTOR'SrDECLARAaTION
rQ hereby affirm that I am;jicensed under pro; ision jof,Chapter-9 (commencing with Section
d000) of Dionl3 ofahe Busineskarid'Professions Code, andrmy license is in full force and -
effeCl. ,5� +: ,- ��'i - _J. ir�A ,
SIGNATURE - 'R c DATE
-OWNER
•BUILDER DECLARATION
I hereby affirm that t am exempt from the Contractor's License Law for the.following
reason: (Sec. 7031.5,Business and Professions Code: Any city or'county whlch,,requires a
permit to construct,; alter,. Improve; demolish, or repair any structurej prior to its issuance, also
requires the applicant for -.such permit to file a signed statement that he is licensed puisuant 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, Wand the basis
for the alleged ezemptfon.. 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,.oi'my, employees with wages as their sole compensation, will
do the work, and the structure.is not intended or offered for sale. (Sec: x044; suisness and
Professions Code: sThe Contractor's; License Law does not apply to an owner of property who
builds or improves:fhereon�and who does such work himself or through his own employees,
• provided that such'"Improvements are not intended dor offered for sale. If,; however, the building
or improvement is sold -,within one year of completion, the owner-bdilder 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=projecti,(Sec.i7044;•Business and Professions Code: The Contractor's License Law
doesfnofiipply;t&anCowner of property who builds or Improves thereon, and who contracts for
a such'"projects,with a-contractor(s)'licensed pursuant to the Contractor's. License. Law.) - -
am exempt under Sec. , B. & P.C. for this reason
m it e a
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
13r60'py is filed with the city..-; O Certified copy is hereby furnished.
F
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.)
-1 certify that in, Performance' of lhp 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
Laves of California. ` ;
Date
NOTICE TO -APPLICANT. -.1f, after making .this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply wlth such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) .
Lender's Name
Lender's Address - - ��_-'•. • '
This is a building permit when properly filled out, signed anil'validated; and is subject to
expiration if 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 u
City, State, Zip
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Pool an 'pa
12303
Sq. Ft. No. No. Dw
Size Stories Units
New ❑ Add ❑ Alter p Repair ❑
:stimated,Valuation $12,5410..,
PERMIT .
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
-Infrastructure
TOTAL
AMOUNT
r.
•� ,.
144.00.
.-r.
• 00
45.00
Demolitiori'❑`.`'
y
.00
. • V e+
F
ZONE:
BY:
Minimum Setback Distances:
4�
Front Setback from Center Line
• :: Rear Setback from Rear Prop. Line
AMOUNT
®d
REMARKS
93.6.0
•� ,.
144.00.
.-r.
• 00
45.00
y
.00
ZONE:
BY:
®d
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
• :: Rear Setback from Rear Prop. Line
'A"' Side Street Setback from Center Line
s {`
Sid
57%PEC
,,--• -_�
..FINAL DATE
�� R
`
Issued by:
Qater
,•
�J
Validated by:
r�
_.Validation:
^� ._ is ,. '• ,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT.
FORMS
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEGUIP.
DRAINAGE PIPING
CARP. SO. FT. ®
GAS (FINAL) TEMP. POLE
WALL SO. FT. p
GROUT
DRINKING FOUNTAIN
SO. FT. ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FRAMING
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
REMARKS:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
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
MESH
SO.FT.GAR @ 3/ac
HOUSE SEWER
INSULATION/SOUND
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 GOND. SOLAR
SETBACK
GROUND PLUMBING?—��3 UNDERGROUNDC7;27-1/3
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) 9s2 2-9 METER LOOP
HEATING (FINAL)
OTHER APPJEGUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
yd.
$ —plus—x$—=$
LUMBER GR.
FINAL INSP. `i(cu.
[6
FRAMING
FINAL INSP.
c l [ J
ROOFING
�� ln(/✓1 (�/ L
!/fG C C� l C ✓
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION a`` D L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES11NITIALS
GARDEN WALL FINAL