14593 (RPL)Pr .F
Y
' 4
P.O. BOX 1504 N o • 14593
Bujldjng 47-115 Via Lorca LA QUINTA, CALIFORNIA 92253
Address
Owner- Landr X
Mailing BUILDING: TYPE CONST. OCC:•GRP.
Address 47-305 Via Rave-nna '
A.P. Number
City Zip Tel.
La Quina,, 92253 5645407 Legal Description
Contractorpool and Spa
C'c'u3 ifbrhia Pt 61's & Spay Project Description
A dres Cit
- . -
PaYJ. is D€ sera, C1 zip 92261 Tel.: 34® -9000 -
State Lic. City
& Classif..0-53 195102 Lic. # 355 Sq. Ft. No. No. Dw.
Arch., Engr., -' Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby,affirm that I am licensed under provisions of Chapter 9 (commencing with Section r
7000) of Division 3 of the Buffness and Professions Code, and my license is in full force and
effect.
SIGNATURE t .d DATE
f OWNER -BUILDER DECLARATION $91000 �
1 hereby affirm that I am exempt from the Contractor's License Law for the following Estimated Valuation , 000
.00
reason: '(S'ec. 7031.5;Business and Professions .Code: Any city or county which ,requires a
permit to�c." ruct, alter, Improve, demolish, or. repair any structure, prior to, its issuance also- I -
requires the applicant for such permit to rile 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 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 Plan Chk. Dep..
subjects'the applicant to a civil penalty of not more than five hundred dollars ($500). . -
❑ l,. as owner the property, or -my employees with wages as their sole compensation, will Plan Chk.'Bal. 70.20
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Cor1St. 0�
Professions Code: The Contractor's License Law does not apply to an owner of property who a 10� • 0
builds or improves thereon and who does such work himself or through his own employees, . Mech. - 24..,0l0
provided that such improvements are not Intended or offered for sale. If, however, the -buiiding
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-i,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.1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ,
C1I am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Enc.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
1 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. f 1 Company
❑ copy is)Iiled Nh the city, O Certified copy is hereby furnished.
9 TOTAL 274.20
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 the 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: ff, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
` Rear Setback.from Rear Prop. Line
WARNING: FAILURETO SECURE WORKERS' COMPENSATION'COVERAGE IS UNLAWFUL, AND Side Street Setback from Center Line
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, Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION,3706 OF THE -LABOR CODE,.INTEREST, AND -
ATTORNEY'S FEES. - -
Tliis _ is a building permit when properly filled out; signed and validated, and is subject to.: FINAL DATE . INSPECTOR
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. Issued by: Date—PefFLllt>� -
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 -n \
mentioned property.for inspection purposes: Validated by:
Signature of applicant Date
Mailing. Address Validation:
City, State, Zip III
CONSTRUCTION ESTIMATE I NO. I ELECTRICAL FEES I NO. I PLUMBINU
1ST FL. SQ. FT. ® $
UNITS
NDERGROUND
2ND FL.SO. FT.
COLL. AREA
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SD. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
GAS (ROUGH) ' /- % %_
��`�
DRINKING FOUNTAIN
SQ. FT. ®
OTHER APPJEQUIP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
TEMP. POLE
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
_$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FINAL INSP.
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
HOUSE SEWER
LATHING
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
ROUND PLUMBIN i V%
NDERGROUND
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 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
[l2 i! i
c ,J
REMARKS:
VENTILATION
FIRE ZONE ROOFING '
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION044
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL