11047 (RPL)4
P.O. BOX 1504
Building 78-105 53-425 4ELASCO LA QUINTAC
Address CALIFORNIA 92253
.. 1
MIKE & DEBBIE SCAJONE
Mailing
Address SAME
City LA Q INTA Zip Tel.
SAME 1 92253
CALIF WATER CREATIONS
74333 SWY 311 — 101
CityZip Tel.:
PALM DESERT 92264 1 776-8181
State Lic.
& Classif. C53 563347
Arch., Engr.,
Designer
Address
BUILDING: TYPE
Number
Description
No. 11047
17
OCC: GRP.
Project Description POOL AND DECKING
Lic. # 2024 [!New
. Ft.
Size ze
❑
Tel.
CityI Zi p I State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed underprovisioQof Chapter 9 (commencing with Section
7000) of Division 3'of the Business fessidns'Cod�,and my license is in full force and
,�
effect. f and`P o&I114 /
,t'. It n �,, �.
SIGNATURE ,/ DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors 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 rile 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 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 penalty of not more than rive 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, 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. If, 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.)
❑ 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 bnproves 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 certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed If the permit is for one hundred dollars (8100) 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 Call ornia.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the tabor 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 state that the above information is correct.
1 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
Add ❑ Alter ❑
No. DIN.
Units
Repair ❑
Demolition ❑
3i:Imarea valuation
$9,600
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. t
$76.05
Const.
117.00
Mech.
24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
1.00
Grading
Driveway Enc.
Infrastructure
TOTAL $290.05
REMARKS
-liNr"4c>-G.4- a:'hS.sir.iii.r,.—+(1'•:,,.r+.`.a•.;at. ,r,)
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
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
2ND FL SQ. FT.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SQ. FT.
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
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
GRADING
yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEWPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ®c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ic
HOUSE SEWER
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE M=CH.FEE
PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
INSULATION/SOUND
FINISH GRADING
STRUCTURE f/ ZPLUMBING 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
P
FINAL INSP. 7 ((,�
FINAL INSP. -7112cu.
GRADING
yd.
$ plus x$
-$
LUMBER GR.
FRAMING
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