09257 (RPL)Yw
T44
P.O. BOX 1504 .' �r No 0925T _
Building 78-105 CALLE ESTADO .. r '
Address 84�-�JLt3.nri LA QUINTA,"CALIFORNIA 92253
'-Owner
Annri � iy. t ,
/ Mailing. BUILDING`, �TY.PE CONST:. n•OCC. GRP. '
Address 42-600 Cook Street 0200 A.P. Number
City Zip Tel.
PaIm DeSe 't 92260 ..568-2828 Legal Description:
Contractor Project Description
G H Pool Construction
Address. z& `0 3+V
68-465 Perei Road
City Zip Tel.:
Cat,, . City 92.234 328-268.1
State Lic. City
& Classif. Lic. # Sq. Ft. No.,:
��� 69 Size Storiesi
Arch- Engr.,;
Designer New 0 Add 0'Alter ❑
Address Tel.
^CityZip State -
Lic. #
_ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section r
:-57000) of Divisio 3 of tthhe/,8usin!p and Proffee��sions Code?—ana-m license is in full force and r
effect. f _1C xJ
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SIGNATURE'! •,T'^,P .! '" ATE
OWNER -BUILDER DECLARATION Estimated Valuation
.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 PERMIT' -•r.
;�fhe_provisions o/ the Contractor's License .Caw, Chapter 9 (commencing with Section 7000) of -
No. Dw. '
Units
Repair❑ Demolitiori ❑'
r
r AMOUNT
.; ""v'ston 3 of the Business and Pro/essions Code, or .that. he is exempt there/rom, and the bests
for the, alleged exemption. Any violafton^o/ Section 7031.5 byan applicant /or a permit
Plan Chk. Dep:
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bjects the applicant to a civil penalty ofmore than five hundred dollars ($500).
+
Plan Bal.
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❑-I,.as owner of the property, or.iny employees with wages as their sole compensation, will
,-do the work, and the structure isnot intended Or offered for sale. (Sec. 7044; Buisriess and
Professions code..Contractor's'. Ll cense Law, does not apply' to an Ownerof property who
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' builds -or improves thereon and.who:does. such work himself or through his own employees, •
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.provided that' such improvements are 'not intended or o/tared for sale. 1/, however, the building .
'or
-
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improvement issold within one year o/ completion, the owner -builder will have the burden
'EI@CtrICBP
o/ proving that he did not build or improve for the purpose o/ sale.),
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^ ❑ I, as owner of the property, am exclusively contracting withlicensed contractors toLcon•
PlUmbing
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• struct the proiecL (Sec. 7044, Business and Professions Code: The Contractor's, License Law
-21
does not apply to an owner o/ property who builds or improves thereon, and who contracts /or
'
S.M:I.
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'.
. such projects with a contractors) licensed pursuant to the -Contractor's License Law.)- • -
.. -
:O Lam exempt under Seca B: & P.C. for this reason
Grading
Driveway Enc.
Date owner
-Infrastructure
WORKERS' COMPENSATION DECLARATION '
hereby affirm that I have a certificate of .consent to self -insure, or a certificate of '
Worker's Compensation Insurance, ora certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. .Company'
9py is filed with the city.: ` ❑ Certified copy is hereby furnished..
TOTAL
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CERTIFICATE OF EXEMPTION FROM
REMARKS.
WORKERS' COMPENSATION INSURANCE
(This section need not be .completed I/ the permit is for one hundred dollars ($100) valuation
�' -' "''�`. N.4C�irt t�"i"4P.�1 r/`�S8 �t38. 43 a3c/ 74'
.. .or less.)
I certify that in the performance of lhp work for. which' this permit is issued, I shall not
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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'
. comply with such provisions or this permit shall be deemed. revoked. , . .,,
-
Minimum Setback Distances: -
•
Front Setback from Center Line
Rear Setback.from Rear Prop. Line
s CONSTRUCTION LENDING AGENCY "
Side Street Setback -from Center Line
hereby affirm that there is a construction' lending agency for the performance of the
work,for which this permit is issued. (Sec. 3097, Ciwl.Code.) .
` Side Setback from Property Line
Lender's Name
_•
Lender's Address
'signed
FINAL DATE
INSPECTOR
This is S building permit when properly filled out, 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.,
Issued by: -
Date • Permit
I agree to comply with all. city and county ordinances and state laws -relating to building
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construction, and hereby authorize. representatives sof .this city to 'enter the above-.
-
..
mentioned property for inspection purposes.
Validated by:
Signature of applicant Date
F
Mailing Address
Validation:
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City, State, Zip
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
Sp FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WAIER 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 APP./EQUIP.
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 ® 11/4 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 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 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.
INAL INSP '
FRAMING
FINAL INSP.
ROOFING
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