14249 (RPL)•4 Qulk&
P.O. BOX 1504 1110. 14249
Buildin 55-403 Riviera 78-105 CALLE ESTADO
Addres LA QUINTA, CALIFORNIA 92253
Owner Genadry
BUILDING: TYPE CONST. OCC: GRP.-
Mailing
Address SaMe
A.P. Number
CityZip
Legal Description
ContractorPool and Spa
California Pools a Spas Project Description
,0 Boardwalk :A-2
'Palm Desert, ziP 92211 Te1340--9000
State Lic. City
& Classif. C-53 1852.42 Lic. # 355 Sq. Ft. No. No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
R. LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I amlicensed under provisions of Chapter 9 (commencing with Section
78g00) of Division,,3 oft e`Busrnes nd Professions Code, and my license is in full force and
re fect. ! t A
SIGNATURE N /A / y DATE
1 OWNER•BUILDER DECLARATION Estimated Valuation
I hereby affirm t j -I am exempt from the Contractor's License Law for the following $13,000.00
reason: (Sec. 7031. S,�usiness 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 - AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division3 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). 93.;60
❑ I, 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, Buisness and Const._ 4 �' �_
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. W-
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 Electrical �_ •
of proving that he did not build or improve for the purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing I • ��
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. 1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
t WORKERS' COMPENSATION DECLARATION
I hereby affirm eat I have a certificate of consent to self -insure, or a certificate of
Worker's CompeWtion Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. 4#' Company
❑C�. filed with the city. ❑ Certified copy is hereby furnished. _
TOTAL
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.) T
I certify that in the performance of the work for which this permit is issued, I shall not 2, 4 1994
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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: y
comply with such provisions or this permit shall be deemed revoked. A`
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address 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 Permit
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. Validated by:
Signature of applicant -Date-
Mailing
ateMailing Address Validation:
City, State, Zip
r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. @ $
UNITS
COLL. AREA
u r
SLAB GRADE
,
2ND FL. SQ. FT. @
HEATING (ROUGH)
YARD SPKLR SYSTEM
POR. SQ. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SQ, FT. @
POWER OUTLET
ROOF DRAINS`
CAR P. SQ. FT. @
FOUND. REINF.
DRAINAGE PIPING
WALL SQ. FT. @
HEATING (FINAL)
DRINKING FOUNTAIN.
SQ. FT. @
REINF. STEEL
URINAL_ _.
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GRADING
cu. yd.
$ plus x$
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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
FIRE ZONE ROOFING
SQ. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID @ 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ 3/ac
HOUSE SEWER
i
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 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 APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
t
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
FINAL INSP,
a
FRAMING
FINAL INSP.
ROOFING
'
'
REMARKS:
i VENTILATION
FIRE ZONE ROOFING
S FIREPLACE
t
I SPARK ARRESTOR
GAR. FIREWALL
R t
LATHING
f MESH
t
INSULATION/SOUND
FINISH GRADING
i
I FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
i
i
GARDEN WALL FINAL