11691 (RPL)f�
Building
Owner
ulden 9vans
P.O. BOX 1504 f
o 78-105 CALLE ESTADO
Ubon LA QUINTA, CALIFORNIA 92253 '
Mailing
Address 77-500 Calif: Chi llon
City Zip Tel.
La Quinta, CA 1 92253
Contractor r
Swan Pools
No. 11691
BUILDING: TYPE CONST. OCC: GRP..
P. Number
Legal Description
Project Description Pool
77-750 Sprinc;ifield Lane
)
City -
Palm Desert, C:�
Zip
92260
Tel.:
360--7926
.•
State Lic.
City
-
& Classif.
Lic. # 249
Sq: Ft.
No., No. Dw.
•
Size-
Stories Units
Arch., Engr.,
Designer
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Address 4
Tel.
City
Zip
State
Lic: # ,
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.
-
SIGNATURE DATE
OWNER -BUILDER DECLARATION '
I hereby affirm that I am exempt from the Contractor's License Law for the following
Estimated Valuation$8,700.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a.
permit to construct, after, 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
�z the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation or Section 7031.5 by 'any applicant for a permit
subjects the applicant'to a civil penalty of not more than five hundred dollars ($500).
O I, as owner of the property, or my employees with wages as their sole compensation, will
„ PERMIT
AMOUNT
Plan Chk. Dep. .
Plan Chk. Bal.
i U .2 U
Const.
I U F. U U
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
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.:lf, however, the building
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.)
O 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
Mech.'
L
Electrical
` 285. UU
Plumbing
_
,d7 • U U
S.M.I. -
• U
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O I am exempt under Sec. B. 8 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,- or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
opy is filed with the city. O. Certified copy is hereby furnished.
TOTAL
� f � • ='U
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
REMARKS
--...�-,� ..,. �, .+...+.a .,,h r...
2'{x• ` e L74�TT I -10 f i s -
(This section need not be completed If the permit is for one hundred dollars ($100) valuation
• or lei certify that In the performance of the work for which this permit is issued, 1 shall not
employ any peon In any manner so as to become subject to the Workers' Compensation
Laws of Californirsa.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate or 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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
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.)
Side Setback from Property Line
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.
FINAL DATE
INSPECTOR
`\
I certify 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.
Issued by:
Validated by:
,
Date�f ermit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
18T FL. SO. FT. ® $
UNITS
SLAB GRADE1?7,ZeROUGH
PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SO. FT. ®
FORMS ( (J
v
SEWER OR SEPTIC TANK
POR. SD. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT. ®
OTHER APPJEQUIP.
DRAINAGE PIPING
WALL SO. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SO FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
_$
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
VENTILATION�`(��
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
MESH
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/ --S %
tt> UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE1?7,ZeROUGH
PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS ( (J
v
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REIN
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
C! "
REMARKS:
VENTILATION�`(��
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION2F�S34
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL