13720 (RPL)Tilly � Quilara
Building r r
Address
Owner
Mailing
Address >%cilrir.'-
City Zip Tel.
5 3
Contractor
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Ciiy -it', Zip Ca r 22 3Tel. yy
State Lic. ;3 �� City 1
& Classif. Lic. #
Arch.. Engr.,
Designer
Address Tel.
City jf Zip State
Lic. #
1
r t ' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
� 7r otcDipislop 3 of the &Gsf LTs .aftd Professions Code, and my license is in full force and
► fect. F t _..
sirtrun111Ri � SATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sac. 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 issuance also
requires the applicant for such permit to file a signed statement that he Is liceireed pursuant to
the ptovWons 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 penally of not more than five hundred dollars ($500).
7 I, as owner of the property, or my employees with wages as theiT sole compensation, will
do the work, and the structure Is not intended or offered I& sale. fSec. 7044, Bwsrress and
FWesatotls Code: The contractor's Llcanse Law does not apply to art 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.)
❑ 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 to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed 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. fSec. 3800, Labor Code,)
Policy NO --Company
i-1 Co _wisTred with the city. 7 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.)
I certify that In the performance of the work for which this permit is issued, I shall not
employ any pparson in any manner so as to become subject to the Workers' Compensation
Laws of CaliTornia.
Date Owner
NOTICE TO APPLICANT: if, after makrng this Certificate of Exatmrich you should become
subject to the Workers' Compensation provisions of the Labor Coda, you must forthwith
comply with such provisions or this permll 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 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 agrea to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize rspresentatives Hof this city to enWr the above-
rrisntioned property for insptictrpn purposes,
Signature of applicant _ Data
Mailing Address
City, State, Zip
No.
BUILDING: TYPE CONST. OCC. GRP
A.P. Number
Legal Description
Project Description
Sq. Ft.
Size
No.
Stories
13720
No. Dw.
Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
_ , v , t_ .r
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const,
Mech.
Electrical
Plumbing
S.M.I.
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 DATE
INSPECTOR
194
Issued by:
Date Permit
Validated
�1 4.
by:
Validation:
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL SO. FT.
2ND FL. SQ. FT.
POR. SQ. FT.
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SO. FT.
SQ. FT. @
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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 R 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.IEQUIP.
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
AL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIG HATIIRESIINITIALS
GARDEN WALL FINAL
❑l
�] cQ\HEM
r 1 .1 t0 C,.�
,
— � r, 4. ',,Z, r--A � y
POOL AREA TO BE ENCLOSED BY
M�NMUM 5FT- HGHF
is ALL GATES TO BE S€.LF-CLOS N
AND SELF -LATCH - NG.
SPA SPECS.
GENERAL SPECIFICATIONS
Lz)U
SIZE 7'
--WATTS
SIZE AREA
DEPTH
QED
RAPE PERIMETER
TRI LEVEL SEATS YES
TILE SIZE _
Y
22" 24" 27"
TILE COLOR
DAMWALL WIDTH
COPING COCO FLATS
,` Ip Q r(
SPILLWAY SIZE X
COPING COLOR
`
SPILLWAY
POOL CAPACITY r GALS
OPEN X. CLOSED
PUMP CAPACITY GPM
MOTOR HP ZHP HP
FILTER STARITE 000 sQ FT
FILTER RATE GPM
TURNOVER HRS
VACUUM LINE & 2�
�7�
I
SKIMM5ER
MAIN DRAIN
SKIMMCHECK ER MODEL
LLvF-
�-c_o \L Cp�� 1 �q y HEATER LAA S SIZE
_?.) Et,\LA
A
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......ram..,.--�j; :� ''y'1.-I'•f, .1�V.. �i'J.r..J �i- C F'E-0W-3 in
N
GASLINE BY SAC
POOL UGHTa X
SPA LIGHT
CLOCK - .
ELECTRIC BY SDC
ELECTRICAL BONDING BY:
71LE AND COPING SCC
DECKING BY
n
9.9
CONTRACTOR cannot assume
responsibility for damage to
curbs, sidewalks, driveways,
cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
or shrubs. When access is made
through a neighbor's property it is
understood that you, the owner,
have that neighbor's permission
and assume Tull responsibility.
Name- INGRAM
Address-, 79790TANGELO
� , y LA QUINTA 1-1 "77/-3/30
w -77/— /99 1
Dodson
�J Pool's
CIW ROOM
68-80S-A PERZ RD. STE. E-9
CATHEDRAL CITY CA. 92234
PHONE (619) 324-123Z
LIC A-574127
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