15850 (RPL)44
P.O. BOX 1504
Building 43--135 Via Vallarta. 78-495 CALLE TAMPICO
Address LA OUINTA, CALIFORNIA 92253
Uwne•r
- - T.D. Desert Development
Mailing
Address P.0. Box 1716
City Zip Tel.
La Quinta 92253
Contractor
California Pools and Spas
Address
74'725 Jori Dr. #A
City Zip Tel.:
Palm Desert 92260 340-9000
State Lic. City
& Classif. 65612€3 Lic. # 35S
Arch., Engr.,
Designer
Address Tel.
;ity
I
Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affiim that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Diyvis`ion,3,#of the Busintess and Profe slons Code, and my license is in full force and
eff
I.
„! , r _a � `a
OWNER -BUILDER DECLARATION
i I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,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
the provisions or 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 or 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 or completion, the owner -builder will have the burden
of proving that he did not build orsnprove 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 or property who builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. tl P.C. for this reason
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.)
Polic ,, No. Company
ACopy 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 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
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 issubject 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
City, State, Zip
LDING: TYPE CONST.
Number
No. 15850
OCC. GRP.
Legal Description -
Project Description Spa Only
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation $6,000.00
PERMIT. AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$52.65
Const.
$81.00
Mech.
$24.00
Electrical
$45.00
Plumbing
$27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL $229.65
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center kin
Rear Setback from Ream1n\iteine_
Side Street Setback froSide Setback from Properorty L
FINAL DATE IMgP-FF1 t
Issued by: Date
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
2ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM
HEATING (ROUGH)
STORAGE TANK
.
t
POR. S0. FT. ®
MOBILEHOME SVC.
BAR SINK
I'
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
%
CAR P. SO. FT. ®
DRAINAGE PIPING
L "
WALL S0. FT.
GAS (FINAL)
DRINKING FOUNTAIN
SO. FT. a
URINAL
GROUT
ESTIMATED CONSTRUCTION VALUATION $
SERVICE
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
WATER SYSTEM
MECHANICAL FEES
WATER SOFTENER
GRADING
cu. yd.
plus x$
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
FINAL INSP..
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
ROOFING
FURNACE UNIT WALL FLOOR SUSPENDED
//1
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
FIRE ZONE ROOFING
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
SPARK ARRESTOR
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
FINISH GRADING
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. _
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
-SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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
$
GRADING
cu. yd.
plus x$
- -
=$
LUMBER GR.
FINAL INSP..
FRAMING
FINAL INSP.
ROOFING
(/�►
//1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIONATURESIINITIALS
GARDEN WALL FINAL