14511 (RPL)44
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
'No.. 14511
Address . 0O—g0Q VI'sta $C3nits'i LA QUINTA, CALIFORNIA 92253
Owner '
:dill xam- J. 'Lyon Roden
Mailing
Address SaMe
City Zip Tel.
%a Quinta CA 2` r
Sractor
Mason Pools
Address.
68-805 A Perez dela EV
...City _._ Zip Tel.:
Cathedral Cit . CA 92234 324-1232
State Lic.c City
& Classif.. A 5.74127 Lic: # 2044. .
11LDING: TYPE CONST:: OCC: GRP.
P. Number
!gal Description
oject Description Pool and Spa
Sq. Ft. No. No. Dw.
Size Stories Units
' Designer
New ❑ Add ❑ '
: Alter ❑ Repair ❑ Demolition 0
Address
Tel.
City
Zip
State
Lic. #
Rear Setback from Re r P o . Line
- -
-Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES'UP.TO ONE
Side Street S.etb m Cen
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section .
7000) of Division 3 of the Business'and Pfrfesslons Code, -and my license is in full force d
�j
effect. ✓i'� '� �7i' S
Side Setback, from P pe �e "
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
G
SIGNATURE rX s DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License law for the following
reason: (Sec. J031.5 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 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).
O 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, 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 have the burden
of proving that he did not build or improve for the purpose of sale.) . -
O 1, 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 contractor(s) (lcensed pursuant to the Contractor's License Law.)
11I am exempt under Sec. B. fl P.C. for. this reason
Estimated Valuation
$16000.00
!
PERMIT
-
AMOUNT
Plan Chk. Dep.
I certify that I have read this application and state. that above informationis'correct.
Plan Chk. Bal,
i •
Const.
•
Mebh.
Electrical
Plumbing
•
S.M.1.
_
Grading
Driveway Enc.
Date Owner
Infrastructure
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
❑ Copy is filed with the city, ❑ Certified copy is hereby furnished.
r
TOTAL
J IF 0• a
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 arson -in any manner -so as to become subject to.the Workers' Compensation
Laws of California
REMARKS
ate Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: BY: - -
• subjectio the Workers' Compensation provisions of 'the Labor Code,. youmust forthwith
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances:'
Front Setback from Center Line
•
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND.
Rear Setback from Re r P o . Line
- -
-Line
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES'UP.TO ONE
Side Street S.etb m Cen
• HUNDRED THOUSAND DOLLARS ($1D0,000), IN ADDITION TO THE COST.OF COMPENSATION,
Side Setback, from P pe �e "
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
G
FINAL DATE SPfR,
-
This is a'buildin g permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
�(QR
I certify that I have read this application and state. that above informationis'correct.
Issued by: Date41
I agree to comply with all city and county ordinances and state -laws relating 90 building
construction, and hereby authorize representatives ±of this city to enter the above-. • • .
for inspection
}
S
/
mentioned property purposes.
jj
Validated by: ..+
Signature of applicant Date
.Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
2ND FL. SQ. FT. p
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. 'SO. FT.
WALL SQ. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
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 lx 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
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL 71