09203 (RPL)P.O. BOX 1504 No. 09203
Building 78-105 CALLE ESTADO
Address 44-125 VILLETA DRIVE LA QUINTA, CALIFORNIA 9225
Owner POOL AND SPA
LON BADS BUILDING: TYPE CONST. OCC:•GRP.
Mailing
Address SAME
A.P. Number
City Zip Tel.
t 4 S — 13 Legal Description
Contractor Project Description POOL ANPISPA
n� 7 r? v n Tal s ..
Ad cess
92260 1346-6335
State Lic. 520432 City
8 Classif. dr0�a® Lic. # 1366
Arch., Engr.,
Designer
Address Tel.
City Zip State
Lic. #
f/ LICENSED CONTRACTOR'S DECLARATION
I ]ler" eb affirm that I am -licenses under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of ttfe Busings3 aqd PnSfessions Code, and my license is in lull force and
iOWNER-BUILDER DECLARATION ' f
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 constiuct, alter; improve, demolish, or repair any structure, prior to Its issuance also,
requires the applicant for such permit to file 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 l; 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 wear of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
Cl I, as owner of the property, am:exclusively contracting with licensed contractors to con-
struct -the project. (Sec. 7044, Basiness -and Professions Code: The Contractor's License Law
does'notapply to an owner of property who builds or improves thereon, and who contracts for
• suchprojects with a contractor(s) licee:sed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS COMPENSATION DECLARATION
I hereby affirm that I have u certificate of consent to self -insure, or a certificate of
W$$r�kffeeyr's Co pensatigq(� nsurance. or a certified copy thereof. (Sec. 3800, Labor Code.)
Poliayl 3�1�J� Company STA4'rF
❑ Copy 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.) .
1 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: It, after making this Certificate,ofExemption you should become
subject to the Workers' Compenaa�ition provisions of the Labor Code, you must forthwith
comply with 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 issuec. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when I=roperly filled out, signed and validated, and is subject to
expiration if work thereunder is suEDended 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 an9 county ordinances and state laws relating .to building
construction, and hereby. authori=e representatives -of this city to enter the above-.
mentioned property for inspection ;Iurposes.
Signature of applicant Date
Mailing Address
City, State, Zip
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop.. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATEINSPECTOR
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size
No. No.Dw.
Stories Units,
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation]
12S500
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
91.60
Const.
.144.00
Mech. '
'24., 00
Electrical
Plumbing, '
27600
S.M.I.
s 1 .. 1
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop.. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATEINSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL. SQ. FT.
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ, FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APP./EQUIP.
DRAINAGE PIPING
CAR P. SQ. FT. ®
TEMP. POLE
WALL SQ. FT.
GROUT
DRINKING FOUNTAIN.
SQ FT ®
FINAL INSP.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WAIER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
GAR. FIREWALL
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/e c
SEWAGE DISPOSAL
MESH
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE jPL.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
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL