11326 (RPL)P.O. BOX 1504 No.. -.11326
Building 78-105 CALLE ESTADO
Address 4 4 -29 Q _ Vll lets LA QUINTA, CALIFORNIA 92253 '
:- `Virginia Clark :
Ma ing BUILDING: TYPE CONST. -__--:OCC. GRP. -
Address same
A.P. Number
City Zip Tel
Lar2uiIrl ta 92253 772-6995 Legal Description
Contractor Project Description _
Allied Pool
Address Pool a-nd Spa t
43580 Palmilia
City Zip . - Tel.:
P.D. 92260
State Lic. City
BClassif. ..C53..-542.660. Lic.V 1540
Sq. Ft. No.: '` No.Dw. -'
Arch., Engr., Size Stories . Units
Designer New 0 Add ❑ Alter 0' . Repair 0 -'Demolition-0
Address Tel.
-City ;Zip State
Lic. # .
LICENSED CONTRACTOR'S DECLARATION
1 hereby.affirm thf0'1 atm licensed under provisions 9 (commencing with Section
000) otivlgjonTof the Business and P fesslo e, and my license Is in full force
and
SIC;NATURE DATE
OWNER -BUILDER DECLARATION ' .
I hereby affirfn that I am exempt from the Contractor's License Law for the following.
• reason: (Sec.• 7031-5,Buskiew and ProfessionsCode: 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 No a signed statement Met he Is ilcensed pursuant to.
the provkipns o/ tAe Contrectors License Law, CAapter 9 (carrarnencing whir Sectbn 7000) of
3 0/ the Business 8rmtl Pro%ssfons Code, or .Mat. Ae k exempt therelrom, and Me basis
�treged exemption. Any vtolatior o/ section 7031.5 Dy any applicant mor e . permit
gpp/icatmr ro a ch�a penalty snot more Man ftve Hundred ddlars.(ssoo). -
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. 7004, Buknass and
Professions Code: The Contractor's License Lew, does not appy to. an owner of property who
builds or improves Hereon era wAo does such work Ainsell or through irk own employees.
. provWetl Nat such irproverrrernts are not imtenuled or oHeretl for sale. fl, however, Me building .
or Improvement'is sold within one year of completion, Me owner -builder will have Me burden
of provfng that he.did not build or improve for the purpose of sale.)
Estimated Valuation
1C
-
'PERMIT
Plan Chk. Dep.
.plan 'Chk. Bali.
Const.
_
Mech. .
:Electrical `
Plumbing
O I, as owner of the property, am exclusively contracting with licensed contractors to com
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not appy to an owner of prop" -who builds or kriproves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law:)'
❑ 1 am exempt under Sea a- g P,C. for this reason
S.M.I. '
Grading '
Driveway Enc.
Date owner
-Infrastructure
WORKERS' COMPENSATION DECLARATION
Laws of California
Date owner '
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 fumished.
ZONE:
TOTAL
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions of this permit shaltbedeemed revoked. - -
CERTIFICATE OF EXEMPTION FROM
REMARKS
WORKERS' COMPENSATION INSURANCE
(This
/iss.ection need not he completed A Me pemW k for one hundred dollars (5100) vahration
j
I certify that In the perfomrance of tip 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: H, after maAdrng thk Certificate of -Exempt/on you should become
ZONE:
- BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions of this permit shaltbedeemed revoked. - -
Minimum Setback Distances: �. .. •
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- 3087, CNil code.)
Side Setback from Property Line
Lender's Name
Len rs..Address
FINAL DATE
INSPECTOR
iibuilding permit when property filled out, signed and validated, and is subject to
-
- 11`work thereunder is suspended for 180 days. '
-
fy that I have read this application and state that the above Information Is correct.-
Issued by:
Date Permit
1 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.
`Date
V,alidated by:
'
• Signature of applicant
Mailing Address
Validation:
City, State, Zip
__•,
BUILDING DIVISION
P.O. BOX 1504 N o . 11326
Building � � 21��a 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253' . .
Owner
Virginia Clark;.
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address same
A.P. Number
cityLa Uinta Zlp 922.53 Tel .772-6935
Legal Description
Contractor AAllied Fool Project Description
-AddressPool and Spa
43580 1�almilla
City Zip Tel..
P.D. 92260
State Lic. City
& Classif. 063 542660 Lic. # 15.40 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 thabl am licensed under Provisions of,Chapter.9 (commencing with Section
7000) of Division -3 of the Business and Professions,Code, and my license is in full force and_,,;
effect..y�` ,
_SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation
.
1 hereby affirm that I am exempt from the Contractor's Lirense Law for the following 00Q
ZS
reason:. (Sec. 7031.5,Business and Professions Code: Any city or county which requires a 1000
permit to construct, alter, improve, .demolish, or repair any structure, prior to its issuance also AMOUNT
requires the,applicant for such permit to rile •a signed statement that he is licensed pursuant to PERMIT
the provisions."of the Contractor's Ccense Law, Chapter 9 (commencing with Section 7000) or
Division 3 otithe Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any vmlation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. -
subjects the applicant to a civil Pena#%• of not more than five hundred dollars ($500). - •
❑ _I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 41605.30
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const..' 6
Professions Code: The Contractor's License Law does not apply to an owner of property who .!1
builds or improves thereon and who does such work himself or through his own employees, Mech.
provided that' such improvements a® not intended or offered for sale. If, however, the building 0{x,
24..
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 45.00
of proving that he did not build or impnve 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. (Sec. 7044,. Business and Professions Code: The Contractor's License Law ,� • 0
does not apply to an owner of properly -who builds or improves thereon, and who contracts for S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O I am exempt under Sec: .. B. 8 P.C. for this reason
Driveway Enc.
Date owner Infrastructure
WORKER:' COMPENSATION DECLARATION
I hereby affirm that I have 3 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.Com anY ' 'id i,?i ie ., _ . ] 4
O Copy is filed with the city. ❑Certified copy is hereby furnished i.S t.l i�
TOTAL 364.80
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKECS'COMPENSATIONINSURANCE
(This section need not be complef9d if the permit is for one hundred dollars (8100) valuation
or less.)
I certify that in the performance of tha 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 Califni
ora.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate or Exemption you should become ZONE: BY:
'subject to the Workers' Compeisatiori provisions of the Labor 'Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. Minimum Setback Distances:
CONS -RUCTION LENDING AGENCY
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.),
Lender's Name
Lender's Address
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.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorze representatives -of this city to enter the above-.
mentioned property for inspection; purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street. Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
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 ® 1% c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
MESH
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
ROCK STORAGE
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
�� V
2 �A? 2-A
/ a/
2-
! �
REMARKS:
VENTILATION
FIRE ZONE ROOFING
1
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL