10259 (RPL)4
P.O. BOX 1504fNo. 10259
Building OHBRR•>I HILL LA gUINTA, CALIFORNIA 92253 {�
Address
Owner ")'F
NIBAUDO
( p ®® BUILDING: TYPE CONST. OCC: GRP.
Addres4
s �2YT§AflflLRDRESS)
A.P. Number
City Zip Tel.
PALM DESERT 92260 340-9000 Legal Description
ContractorProject Description POOL AND -SPA
CALIPb RNIA POOLS
Address
41-910 BOARDWALK
City_ Zip Tel.:
PALM DESERT 340-9000
State Lic. City
&Massif. C53�1S510l Lic .# 305 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
I hereby affirm tnat,I am licensed under provisions of Chapter 9 (commencing with.Section
7000) of Division 3'of the Business 4"d rofessions Code, and my license Is In full force and
effect.
SIDNATl1RE .r• DATE - -
rf OWNER -BUILDER DECLARATION Estimated Valuation
I heretil%affirm that I ern exempt from the Contractors License law for the following 918.000
reason: (Sec. 7091.5,Bualnesa and. Proleasbns Gbde: Any chy w county whk A requhes. a
permit to copstiuct, ager, Improve, denallsA, W repair any structure, prbr to ks Issuance also
.th..'res the
app/kant for such permR to >ue a atgned statement that he re Ikenaed pursuant to PERMIT AMOUNT '
tits provisions of tJra Contracrors Lienee Lew, Chaptw 8 (commencing with Sectlon 7000) of _
Division 3 of the Buaine9s and Professlona Code, w that. he fa exempt therehom, and the basis
for the alleged _exemptlon. Any vlo/atlon o/ Section 7031.5 _by 'any applicant for a permit Plan ,Chk. Dep.
sublecta the eppacanf.to a cN¢,penafty ofnot.more than tive hundred dosars;(5500): plan Chk. Bal. $ 12 ? . $ J
O I, as owner of.lhe property, or my employees with wages as their sole, compensation, will
do the work, and the structure Is not Intended or offered toe sale. (Sec. 7044, Buisness and Const. 189 . 0th
Professions Code: The Contractor's License Law doss- not apply ro an owner of property who
builds or Improves thereon and who does such work himself or' throughhis own employees, Mech. 24.00
provided ,that'such Improvements are not Intended or offered for sale. 11 however, the building
or Improvement is doll within one year of canWeOon,.the owner -builder will have the burden Electrical 45.00
of proving,that he did not build or knprove for Me purpose of sale.)
O 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 27.00
struct the project. (Sec. -7044, Business and Professions Code: The Contractor's License law
does not apply to an owner or property who builds or bnproves thereon, and who contracts for S.M.I.
such, projects with a contractor(s) licensed pursuant to the Contractor's. License Law.)
❑ 1 am exempt under Sec. R• & P.C. for this reason Grading
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, ora certificate of
Worker's Compensatlon Insurance, or a certified copy thereof. (Sec. 9800, Labor Code.)
Policy No .Company '
-0,C 6py is filed with the city. ❑ Certified copy Is hereby fumished..
y TOTAL 44U9
� : f
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
-(This section need not be completed If the permit is for one hundred dollars ($100) valustkrn .. ,-, n _.•, ., r- . ; . -• �• .4 _ r
or less.) e ,,-., .f - } ; t" Y 0 �. 5
I cert) that, In the performance of th work for which this i :. ttl:r
certify „ p. , p permit Is Issued, I Ghali not
employ.any person in any manner so as to become subject to the Workers" Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT.' fl, after makkV 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 pemnt shall be doomed revoked. M i n i m u m Setback Distances:
Front. Setback from Center Line
RearSetback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a constriction lending agency for the performance of the
vrork for which this permit ie issued. (sec. 3097. CIO 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,correcl. 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 theabove•.
mentioned property for Inspection purposes. Validated by:
Signatureof applicant _ Date
Malling,Addrese Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. I SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL S0. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN,
SO FT @
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM. FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
AL INS l0
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
41
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.
SO. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 W c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3Ac
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL.FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEEPLUMB. 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 xi
=S
LUMBER GR.
AL INS l0
FRAMING
FINAL INSP.
ROOFING
u
41
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