14797 (RPL)T4.tyl 4 4 a"
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 5' -04`J Ave. Garza=lza LA QUINTA, CALIFORNIA 92253
Owner miller
Mailing
Address
Zip
Tel.
Cfy
' 22453
Contractor
Pools (:on5truatlon
Addres400 Ave.
Ramirez
city
:Ad Quinta,
CA
Zip 0-)253
. r
Tel
564--3655
State Lic.
City
& Classif. C53
658996
Lic. # 2893
Arch., Engr.,
Designer
Address
I Tel.
City I Zip I State
Lic. #
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.
SrwATURE DATE
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 /lie 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).
❑ 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 snprove 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 .Proresions 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) (tensed 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. 3900, 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
or less.)
I certify that in the performance of thip work for which this permit is issued, I shall not
employ any pperson in any manner so as to become subject to the Workers' Compensation
Laws of Ca]ifornia,
Date Owner
NOTICE TO APPLICANT. If, alter makag this Cardiricale of Exomption you should become
subject to the Workers' CouWansarion provisions of the Labor Code, you must forthwith
comply with such provisions or Ibis 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
ATTORNEYS FEES.
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 slate 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. 14797
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 -1 ^
1 0 0 0 . 0 0
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal_
Const.
14 4. 0 iJ
Mech.
24.00
Electrical
4 5 , L0 0
Plumbing
27 , C-1 4
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:
Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBINV, FEES
1ST FL. SQ. FT, @
2ND FL. SQ. FT. Cad
POR. SO. FT. a
GAR. SO. FT. ®
CAR P. Q. FT.
WALL SQ. FT.
SO. 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.000L HOOD
SIGN
WASHER(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,TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ®c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/.c
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 & AIR COND. SOLAR
f .e
SETBACK
GROUND PLUM
UNDERGR LIN
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.
GS�41ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
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
FINAL INSPECTION �y
iL
CERT. OCC
FENCE FINAL
INSPECTOR'S SIGNRTURESliHlTIALS
GARDEN WALL FINAL
Driveway
Garage
Front Street
— -- Equipment
Residence
- - 5'— Ir
51 —040 Ave. Carranza
070
- 10,
M
POOL AREA TO BE ENCLOSED BY
MINIMUM 5 FT. HIGH FENCE.
ALL GATES TO BE SELF -CLOSING
AND SELF -LATCHING.
CITY OF LA QU INTA
BUILDING & ISAFFTY IDEETARTMEENT
L
(�BLE COUES
AND ALL A FPLIC
D ATE j4;L
YCE/ do"
Construction
Pools Spas Fountains
(619)564-3655
Lic. #658996
BUILDING DEPARTMENT
} CITY & LA'QUINTA
OFFICE: (619) 777-7012 INSPECTION REQUESTS: (619) 777-7153
TO:
ADDRESS:
DATE: lzaLo
CORRECTION NOTICE
PERMIT NO. '`JGi5
.K-
Inspector
BUILDING DEPARTMENT
CITY OF LA QUINTA
OFFICE: (619) 777-7012 INSPECTION REQUESTS: (q39 777-7153
TO: DATE:
ADDRESS:
PERMIT NO.
CORRECTION NOTICE
14-7
Inspector