9769 (RPL)4
P.O. BOX 1504 No. 9769
Building4�-065 BALAIiA 7&105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
SCHARBACR BUILDING: TYPE CONST. POOL
Mailing OCC: GRP.
Address SAME
A.P. Number
City Zip Tel.
LA OUINTA CA 192253 1564-6466 Legal Description
Contractor Project Description POOL ONLY
SWAB POOLS
Address -
68-300 RAMON
City lZip Tel.: I( -
CATHEDRAL CI
State Lic.
& Classif. 421014
Designer `
Address
92234 324-4460
Lic. # 2 4 9I Sq. Ft.
Size
Tel.
City Zip StISt to
LICENSED CONTRACTOR'S DECLARATION
�I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect. h'rrr'lrrr ✓! t -- t^ �i�Y%
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 or 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 applicant to a civil penalty of not more than five hundred dollars ($500).
❑ 1, 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, Bulsness 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-bullder will. have the burden
of proving that he did not build or Improve for the purpose or 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.)
❑ 1 am 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 cart ied GCop t ereof.(�c 3g 00, Labor Code.)
Poll No. �� Company VSY t4Li1A4'
7C0Iled with the city. ❑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. d, 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 car Illy 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
No.
Stories
No. Dw.
Units
New ❑. Add ❑ Alter ❑ Repair ❑ -Demolition ❑
3timated Valuation
$13,000
PERMIT
AMOUNT
Plan Chk: Dep. '
Plan Chk. Bal.
$93.60
Const.
144.00 .
Mech.
24*00
Electrical,
45.00
Plumbing
27.€90
S.M.I.
1.30
Grading
Driveway Enc.
Infrastructure
TOTAL -s • V U
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 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST 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. Q. FT. ®
GAS (R0UGH)A 6 C-5
1111 "``"''
DRAINAGE PIPING
WALL SO. 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.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
p�
p l�
lQ`23/40 cb
66
v
LAUNDRY TRAY
AIR HANDLING UNIT CFM
REMARKS:
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 ® IVi c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
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 PLUMBING
DERGROUND
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 (R0UGH)A 6 C-5
1111 "``"''
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
"
BOND BEAM
WATER SYSTEM
GRADING
P. cu. yd. '
$ plus x$
_$
LUMBER GR.
'FINAL INSP. (Lo
FRAMING
FINAL INSP.f!�Ay q
L
ROOFING
p�
p l�
lQ`23/40 cb
66
v
��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIONV�p%% L4
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL