002185 (RPL)cew � Quorw
Ads
Adddreresss 54-092 0* T1W
Mailing
Address 75-GOS sW elm TWiVa
City I Zip Tel.
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Palm Dewxt 92260 5618-2,828
Contractor
ress
City� Zip Tela
Cwt, MY 92253 328-2631
State Lic. City
& Classif. 27, fir Lic. # 69
Arch:,-Engr.,
Designer
Address Tel.
City Zip State
_ _ . Lic: #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that,l am licensed under provisions of Chapter 9 (commencing with Section
70 00) of Divisionn/3`of the�Busl" ess.an'd Professiioonnse''Code, and my license is in full' force and
✓
effect..... > -,5,
SIGNATURE 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 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'epplicant to a civil penalty of not more than five hundred dollars ($500).
O 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 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.) -•
O lam 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. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. O 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 person in any manner so as to"become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, 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.
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 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 -of this city to enter the above-
mentioned property for inspection purposes.'{
Signature of applicant ' Date -� �' �'
Mailing Address _
City, State, Zip
HARD COPY
No. 002185
BUILDING: TYPE CONST. - OCC. GRP.
A.P. Number
Legal Description
Project Description 5+'
0amm Ana Pool and Spa -.FWW8A
Pool -20xata
Spa -10x10
Sq. Ft.
Size-
No. No. Dw.
Stories - Units
New ❑K Add ❑ Alter ❑ Repair ❑ Demolition ❑
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
POOL AREA TO DE ENCLOSED BY
Side Setback from -Property Line
MINIMUM
b Fl. HIGH FENU.
Issued by:
Date 3-14-86Permit
ANP
E SELF=CLOSING
SEE tATPHING.
Validation:
Estimated Valuation
200•00
PERMIT
AMOUNT
`Plan Chk. Dep.. .
Plan Chk. Bal.,
95.32
Const.
146.50
Mech.
25J10
Electrical
14-00
Plumbing
MAO
S.W.
1-44
Grading
Driveway Enc.
Infrastructure
TOTAL
26
3M26
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 3-14-86Permit
Validated by:
Validation:
A 4 8 0 1
3 17 3,r0.26 51
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. '' SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
_WALL SO. FT.
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR 'SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 % c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE 7LUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & 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 APPJEOUIP.
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
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE . -FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL