15864 (RPL)P.O. BOX 1504
ilding 78-495 CALLE TAMPICO
dress 78-595 L Theta LA QUINTA, CALIFORNIA. 92253.
Iner Schwerin & Hunter
Mailing.
Address Same '
City
Zip 'Tel.
Driveway Enc.
La guinta, CA
9225
Infrastructure
Contractor
Allied Pool
Address. 6
43--80 Pc"t3.milla
City -Zip
Palm I3�se.rt,
zzl 32260
Tel.:
State Lic. -
City
& Classif.. C53 542660
Lic. # 1540
Arch., Engr.,
Designer
Address
Tel.
City(Zip ( State
Lic. #
r 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 Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, atter, improve, demolish: or repair any structure, prior to its issuance also
requires the applicant for such pemtit 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 Buslness 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 hive 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 of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
O' 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 toan owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) (incensed 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 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
O Copy is filed with the city.. 0 Certified copy is hereby.furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollars• ($400) valuation
or less.)
I certify that in the performance of thF work for which this permit is issued, I. shall not -
e rploy anyperson in any manner so as to become subject to the Workers' Compensation
L�ws of California.
Date Owner
- NOTICE TO APPLICANT: H, after making this Certificate of Exemption you should become .
subject to the Workers' Compensation provisions of. the Labor Code, you mush 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 is subject to
expiration it 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
No. 1,5864
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description Pool ailld Spa
Sq. Ft.
Size
New ❑
No. No. Dw.
Stories Units
Add ❑ After ❑ Repair ❑ Demolition ❑
$16,0n.00
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
AMOUNT
111I� .
liI Q �a' •
24.00
A Q
4t•0`iACm. A-01
Grading
Driveway Enc.
Infrastructure
TOTAL
'REMARKS
ZONE: • BY:
Minimum Setback Distances:
Front Setback fro f�' a to ine
Rear Setback fro ar Prop. am�ine ,
Side Street Sett/bbic from. rq`eY' e
Side SetbacKf�m Pont L
FINAL DATE �/. INSPEC.C�T
Issued by: Da te+ • Pt
Validated by: j
Validation:
W
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT. p
BONDING
YARD SPKLR SYSTEM
STORAGE TANK
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCKS T ORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SO. Ff.
TEMP. POLE
DRINKING FOUNTAIN
SO. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
i
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
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/. c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/.c
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE I
MECH.FEE IPL.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
ROUGH WIRING
DUCT WORK
ROCKS T ORAGE
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 I SP.
i
ROOFING
1 • J
I`
n
l \\
U
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL