002761 (RPL)P.O. BOX 1504 No.
�
Building r 78-105 CALLE ESTADO
Address .5'-830 PkwkuY' LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address 7_%_W5 00
City
Palm Desert
Contractor
G. H. Pool.
Address
City'
Cathedgal
State Lic.
& Classif. 2757
Arch., Engr.,
Designer .
Address
y Club M:il
Zip Tel.
92260 - I
568-2323
City Zip
LICENSED COI
I hereby affirm that I am%licensed and
7000) of Division 3 of tfie Business and
Tela -.
92234 329'-2.68'1
City
Lic. # 69
Tel.
State
Lic. #
BUILDING: TYPE CONST.- OCC: GRP.
�A.P.-Number,
,Legal Description
Project Description
Sq. Ft. No. No. Dw.
Size ... Stories Units
New CM Add ❑ Alter ❑` Repair ❑ Demolition ❑
effect. h. �_s_,✓ �' - ,y
SIGNATURE ' f DATE
OWNER -BUILDER DECLARATION EStlfTlated
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 -
luation .
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
Plan.Chk...Dep.
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 applicant to a civil penafty of not more'than Yive'hundred dollars ($500).
. ❑ I, as owner of the property, or my employees with wages as their sole compensation, will
Plan Chk. Bal. •
Const.
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
Mech. '
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
Electrical
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.) -
Plumbing
❑ 1, 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
S.M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑.I am exempt under Sec.. B. & P.C. for this reason
Grading
Driveway Enc.
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby 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. ❑ 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 thg 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 if work thereunder is suspended for 180 days.
I certify that I have read this application and slate'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 pur5ioses4 r
Signature of applicant . + � !~, Date r -1 J
Mailing Address �.
City, State, Zip
HARD COPY
Infrastructure
TOTAL
HtMAHKS
AMOUNT
S�m�ittS
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 12 16-8—P-ermit
Validated by:
Validation:
A6935
12 17 50.L3 13
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT.
SQ 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/4c
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 APPJEQUIP.
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
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
M; I UM'b WUNA I UMCbII NI I IALb.
GARDEN WALL FINAL