08747 (RPL)Building
Address
Owner
Mailing
Address
City
Contraet&u-L11T-i2 �7443 a J t
Add reb IalIt rnia Pools & Spas
City — —.. —-[ZTr""' Tel.
State E1el.f xs 1. eS43-rlc !;FIdA:vu City
& Classif. Lic. #
Arch., Engr., 18510'
Designer
Address Tel.
4 aCP Qum&
- P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City I Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under prgvlsions of Chapter 9 (commencing yrlth Section
70pD] of Olvislon 3 of the Business and Prafessions'Code, and my license is in full force and
effect.
SIGNATUREt • • bATe
OWNER -BUILDER DECLARATION
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 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 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).
CI 1, as owner of the property, or my employees with wages as their sole compensatlon, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness and
PrnfesaionR Code: The Contractor's Llcensa Law does not apply fo 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.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Pratessfons Code: The Contracfar'S Ckense 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.)
❑ I am exempt under Sec. B. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I hereby afrlrm 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.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
w lass.)
I Certify that In the performance of thg work for which this permit is issued, I shall not
employ any Eurson in any manner so as to become subject to the Workers' Compensation
Laws of California -
Date Owner
NOTICE TO APPLICANT: If, after makft this Eertfffcafe of Exemption you should become
subject to the Workers' Compensallon provisions of the Labor Code, you must forthwith
comply with such provisions or HIM 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 issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building perftltt 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 Hof this city to enter tho above -
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address —
City, State, Zip
No. ' 7
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
r.
PERMIT r y AMOUNT
Plan Chk. Dep.
_Plan Chk. Bal. it t Const. �_
Mech. Y r
Electrical 24.00
Plumbing 45.00
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
Issued by: —
Validated by:
Validation:
Date Permit
1ST I
2ND
FOR
GAR
CAR
WAL
EST
NO -
VENT
APPLI,
FURN�
AIR HI
ABSOI
COMPI
H EATI
BOI LE
MAX. 1
PERMI
DBL
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES,
r-
L SQ. FT. ®
= L- SO. FT. ®
SO. FT. @
SO. FT. ®
P- SO FT ®
SO FT. ®
SQ. FT.
MATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOMESVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
E- Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
;YSTEM FAN EVAP.COOL HOOD
(SIGN
WASHER(AUTO)(DISH)
,NOE DRYER
GARBAGE DISPOSAL
GE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
NDLING UNIT CFM
KITCHEN SINK
FTIGN SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
IESSOR HP
POLE, TEMIPERM
LAVATORY
IG SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
I B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
EATER OUTPUT, B.T.U.
SO. Fr. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/4c
HOUSE SEWER
GAS PIPING
T FEE
PERMIT FEE
PERMIT FEE
TOTAL FEES
MICRO FEE
MECH.FEE
PL.CK.FEETNST.
FEE
ELECT. FEE
SMI FEE
PLUMB. FEE
STRUCTURE
ESSETBACK
LAB GRADE
FORMS
FOUND. REINF.
REINF• STEEL
BOND BEAM Cn G d L p
LUMBER GR. L
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FIN�INSPECTION�2r [t!
CERT. OCC.
FENCE FINAL
GARDEN WALL FINAL
PLUMBING
ELECTRICAL
GROUND PLUMBING ikl�z/
UNDERGROUND
ROUGH PLUMB.
1,112
SEWER OR SEPTIC TANK
ROUGH WIRING
GAS (ROUGH) 8
1 , / Q
L
METER LOOP
GAS (FINAL)
TEMP. POLE
WATER HEATER
SERVICE
WATER SYSTEM
FINAL INSP.
FINAL INSP. 10(2(tCl(q/)
C
�tff 1612,ZI96) La
10130M C1 U,
HEATING & AIR COND. SOLAR
4o
A.C. UNIT
COLL. AREA
HEATING (ROUGH)
STORAGE TANK
DUCT WORK
ROCK STORAGE
HEATING (FINAL)
OTHER APP.IEQUIP.
FINAL INSP.
G 2( GRADING ! / � cu. yd.
$ plus x$ =$
REMARKS: