09213 (RPL)C&tyl
No.
P.O. BOX 1504
09213
Building r 78-105 CALLE ESTADO
Address �'�-340, �,�,� �.t?gy;R,�3;� LA QUINTA, CALIFORNIA 92253/
/
i"%T-t BUILDING:. TYPE CONST. OCC: GRP.
Mailing
Address
Sam A.P. Number
City• Zip Tel.
La QU a^ 92253 Legal Description
Contractor Project Description
Blue Dol;hin- Pools
.Address..: POOL XND SPA .
City Zip Tel.: ;?_Z -Y,57_0&
Cat
?LZ-
Cat City, .92234 .:
State Lia
City
& Classif.
Lic. #�� 61
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr.,
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.
"'70Qvis`on3 of.theBusiness and Professions Code, and my license is in full force and
e �0)t f
'*
SIGNATURE./ - E.„..'+"w:+. a�✓A u f ZT:...:..r,y_. �e -" i' or -DATE
-
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following'
Estimated Valuation
20,400.00
reason: (Sec. 7031:5,Business and Professions Code: Any city or, county which requires a'
permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuancealso
requires the applicant for such permit to file.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
violation 'any
Plan Chk. De p
:. for. the alleged exemption: Any of Section 7031.5 by applicant for a permit
_ :subjects the applicant to a civil•penaltyof not more than rive hundred dollars ($500).
Plan Chk. Bal.
'
140.40
.''O.I, as owner of the property, or my employees with wages as their sole compensation, will
r do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Const.
". Professions Code: The Contractor's License Law does .not apply to an'owner of property who
•>Q
builds or improves thereon and who doessuchwork himself or through his own employees,
Meth.
24.00
provided that such improvements are, not.intendedor offered for sale.. If, however, the building
or improvement is sold within one ,year of completion, the owner -builder will have the burden
Electrical
- 100of
proving that he did not build or improve for the purpose of sale:)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
27.00
struct the project. (Seca 7044, Business- and Professions Code: The Contractor's License i.Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
S.M.I.
1.47
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.):
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner e
Infrastructure
':'
WORKERS' COMPENSATION DECLARATION
I hereby affirm that'l have'a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance', or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
-
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
453.87
CERTIFICATE OF EXEMPTION FROM
• WORKERS' COMPENSATION INSURANCE
REMARKS
y-x:z z ec(a i+rJ 'R �x�tixr•.itti n -x 1 is; rtim nx s,nc=+ fy.��
'.CV4.Y'$WdY.31Ai19Y.f6.•�aY 'KrV�ih'ih'H� �'T:
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
^Y.tt'iY94✓i
- 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. If, after making this Certificate of Exemption you should become
ZONE:
BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
Setback Distances:.
-
comply with such provisions or this permit shall be deemed revoked.
Minimum
Front Setback from Center.Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
Lender's Name
Lender's Address
FINAL DATE
INSPECTOR
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 certify that I have read this application and state that the above information is correct..
'Issued by:
-Date,-Permit,
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.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
-.. T,
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
(�
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS '
CAR P. SO. FT. ®
DUCT WORK
DRAINAGE PIPING
WALL SO. FT.
DRINKING FOUNTAIN.
SO. FT. ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WAIER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
GRADING
CU. yd.
$ plus x$
LAUNDRY TRAY
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
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 PLUM BI N(012 ? 4(
b UNDERGROUNDa/.11 Cl l (
A.C. UNIT
COLL. AREA
SLAB GRADE
(�
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
O�
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF. ?'
GAS 2p( e, b (ROUGHS/
v l 0
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 Q Z t -i t.
FRAMING
FINAL INSP. / O Gy
ROOFING
O�(y [7 /ila ((O
t(GA IT d`(6 t t
+ter( 1P / �[ ` to
at(��
0
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION 0 ((#I
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL