15836 (RPL) - -
IIIIIII IIIIIIII VIII IIII 68
- IE No. 15836
'-�-- - P.O.Box 1504
Building 78-495 CALLE TAMPICO
-Address 49-641 Avila qtr'.. LA QUINTA,CALIFORNIA 92253
`weer Jerry Horn
?MailingBUILDING: TYPE CONST. OCC.GRP.
Address ����
A.P.Number
City Zip Tel.
La Quinta, CA 922.53 Legal Description
ContractorRelocate pool equipment
�i�tte const.
Project Description
Address Note: Pool eci�ipment to be a mi ninau
P.O. Boxy 2.464 of 5' from property line
CitS Zi Tel.:
sicca Va11.ey, 92284 323-9445
State Lic. City
&Classif.. 28010 Lic.# 1002 Sq.Ft. No. No. Dw.
Arch.,Engr.,
Size Stories Units
Designer New❑ Add ❑ Alter ❑ Repair❑ Demolition ❑
Address Tel.
City Zip ` ` State -
Lic.#
;'LICENSED CONTRACTOR'S DECLARATION
k I hereby affirm that I`am licensed under provisions of•Cha`pt 9(66mmencing with Section
'7000)of Division 3 of the Business and Professions Code,acid my license is in full force and
N.effect " -"J., t . ti. Y, -,,, .i
-51GNATURE -" DATE
OWNER-BUILDER DECLARATION 1
Estimated Valuation �x AA
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Rustness 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 h
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars($500).
O 1,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal.
do the work,and the structure is not intended or offered for sale.(Sec. 7044,euisness and Const-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, Mech.
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year oP completion, the owner-builder will have the burden Electrical ,�. �
of proving that.he did not build or improve for the purpose of sale.)
❑1,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing
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 S.M.I.
such projects with a contractor(s)Pcensed pursuant to the Contractor's License Law.)
Grading
6 1 am exempt under Sec. B.&P.C.for this reason
Driveway Enc.
Date Owner Infrastructure
WORKERS'COMPENSATION DECLARATION
I hereby4affirm that I have a certificate of consent to self-insure, or a certificate of
Worker�''�ssI Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.)
Polic f' o Company
Copy is filed with the city. ❑Certified copy is hereby furnished.
TOTAL 15.00
CERTIFICATE OF EXEMPTION-FROM REMARKS
WORKERS'COMPENSATION INSURANCE
Y
(This section need not be completed H the permit is for one hundred dollars ($100) valuation
or less.) ,
I certify that in the performance of the work for which thrs:p .tw ins 1- ed,I shall not
employ any parson in any manner so as to become'°subjectrtoA ee,Workers'Compensation
Laws of California r V X ti
Date Owner_..=ft"o , r ."`
NOTICE TO APPLICANT:•--ff, after making 4his Certific to of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the -Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or the permt shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop.Line
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND Side Street Setback from Center Line
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, Side Setback from Property Line
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY`S FEES. FINAL DATE INSPECTOR
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., Issued by:, Date ------Pefrnit
1 agree to comply with all city and county ordinances and state laws-relating to building i
construction, and hereby authorize representatives -of this city to enter the above-. !1
mentioned property for Inspection purposes. Validated by: l
Signature of applicant Date !
;,Mailing Address Validation: i
City, State, Zip
7
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBINU FEES
IST FL. SO.FT.® $ UNITS
2ND FL. SQ.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.
POWER OUTLET ROOF DRAINS r
CAR P. I SO.FT.
DRAINAGE PIPING
WALL SO.FT.®
DRINKING FOUNTAIN. i
SO.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL 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,TEMIPERM LAVATORY
HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SO.FT.®c BATH TUB
SQ.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SQ.FT.RESID®11A c SEWAGE DISPOSAL
SO.FT.GAR®3/ac 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
SETBACK GROUND PLUMBIN 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) G� < METER LOOP HEATING(FINAL) OTHER APPJEQUIP.
REINF.STEEL GAS(FINAL) / TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP.
cu.yd.
FRAMING FINAL INSP. $ plus x$ _$
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING'
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
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