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14470 (RPL)P.O. BOX 1504 Bu Add' 45- 005 Desert Fox Thr. 7UINT CALLE CALIFORNIATAMPIO Address LA QUINTA, ORNIA 92253 Scott Black Mailing - Address ®€ami City Zip i La Quinta, CA 92253 Contractor SliziX'ise Pools Address . P.O. Box 12573 Palin Desert, Zip 92255 4State Lic. O_S3 .56236 & Classif. . Arch., Engr., Designer Address 34©-5521 City 1504 Lic. # Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm tha am �f'cer" under provisions of Chapter 9 (commencing th.Section 7000) of Divisi..f3 i f thaf usiness and Professions Code, and my license is in f I fore and, effect. !� , ) h , /. . 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 (le a signed statement that he is licensed pursuant to the provlsions of the Contractor's License Law, Chapter 9 (commencing with Section 7000)- of Dlvislon 3 of the Business and Professions Code, or that. he is • exempt therefrom, and the basis for the alleged exemption. Any vblatbn 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). ❑ 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 orknprove for the purpose of sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business andProfessions 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 Compensatiomin urance, or a certified copy t reoL (Sec. 3800, Labor Code.) Policy No. IrGW /2 .Company S f Copy is filed with the city. . ❑ Certified copy is hereby furnished. . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed ff the permit is for one hundred dollars. ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, I shall not employ anyperson in any manner so as to become subject to the Workers' Compensation Laws 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 must forthwith comply with such provisions or this permit shall be deemed revoked. i 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 3708 OF THE LABOR CODE,INTEREST, AND ATTORNEY'S FEES. - Ttiis 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 agblica ion and state that the above information is correct. I agree to comply with all city,and co�nty ordinances and state laws relating to building construction, and hereby'authorize}rbpresentatives.,of this city to enter the above-.. mentioned property for inspection Grposes. Signature of applicantp ice{ Date - i Molding Address City, State, Zip No. 14470 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Pool-, and Spa Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation 12 t Q o o . 00 ' PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 87.75 Const.' 135.00 Mech. 24.011 Electrical 5.00 - 45.00 - Plumbing Plumbing 27.00 S:M.I. Grading Driveway Enc. Infrastructure TOTAL 313.75 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 fr m/P perty`Line t FINAL DATE INSPEC((Ot Issued by: Dat ey PI? ' Validated by: 9S Validation: ....o . .. CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. ® $ UNITS t GROUND PLUMBING UNDERGROUND rQ YARD SPKLR SYSTEM 2ND FL. SO. FT. p SLAB GRADE ROUGH PLUMB. BONDING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® SEWER OR SEPTIC T/A4K ROUGH WIRING GAR. SO. FT. ® POWER OUTLET ROOF DRAINS GAS (ROUGH) METER LOOP DRAINAGE PIPING CAR P. I SO. FT. REINF. STEEL GAS (FINAL) WALL SO. FT. ® DRINKING FOUNTAIN SO. FT. ® WATER HEATER URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES LUMBER GR. WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY 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 ® 1 Va c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER INSULATION/SOUND 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 �CTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND rQ A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC T/A4K 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 FINAL INSP. GRADING cu. yd. $ plus x$ =$ LUMBER GR. FRAMING FINAL INSP. ROOFING / /J v ` REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL