06830 (RPL)Building
Address 54-231 Southern Hills
� 1�C1�rw
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
owner
Chase _
Mailing
Addrels
City
Zip
Tel.
rots
92253
Contractor
&UforuU Pools & Spas
Address
41-910 Boardwalk A-3
City
Zip
Tela
Pals pert
92260
.340 ,900A „ .
State Lic.
City
& Classif.
Lic. #
Arch., Engr.,
Designer
' Address'
Tel.
City Zip State
Lic. #
i% LICENSED CONTRACTOR'S DECLARATION
I hereby affirm thafl am 1"rcersed uimi$6 prows ons of Chapter 9 (commencing with Section
7000) of bririsian 3'pf the Busies and Professions Code, and my license`is,in full force and
effect ►rx �% R. ?+�, i, 3 :l9 y
al. OWNER -BUILDER DECLARATION '
I hereby affirm that I an exempt from the Contractor's License Law for the following
reason: (Sec 7031-5,11ushess and Professions Gide: Any city or county which requires a
Permit to construct, alter, improve, demolish, or repair any structure, poor to its issuance also
requires the appiramt liar such permit [o tie a signed statement that he is licensed pursuant to
the provbkins of the Ourtracior'S lrcerse Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and PiWessiarxs Code, or that. he is exempt therefrom, and the basis
for the alleged exerrption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a dolt pe ally of not more than five hundred dollars (5500).
❑ I, 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
Professiorxs Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thaean and who does such work himself or through his own employees,
Provided that such irprovernents are not intended or offered for sale. If, however, the building
or improvements sold wilm one year of corr*6tion, the owner buider will have the burden
or proving that he did not build or improve for the purpose of safe.)
❑ 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 appy to an owner of property who braids or improves thereon, and who contracts for
such protects nth a con&acWs) Ece sedpiusuant to the Contractor's License Law.)
❑ 1 am exempt under Sec R & P.C. for this reason
Date Owner
1MORKEW COMPENSATION DECLARATION
1 hereby affirm that 1 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.
CERNFICATE OF EXEMPTION FROM
WORKERS! COMPENSATION INSURANCE .
(rhfs section need not be arrplated d 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
N017CE TO APPLI AW: IF. after mating this: Certificate of Exemption you should become
subject to the Wookers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shah 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, Civif Code.) -
Lender's Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days. `
I certity 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 Addn ss
City, Rtate. Zip
No. 06830
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number FGA Wast
d
Legal Description
Project Description Pool c"JR
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
1/12/90
Issued by: Date - Permit
Validated by:
Validation:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT
AMOUNT
.Plan Chk. Dep.
Plan Chk. Bal.
$ 87.75
Const.
235.00
Mech.
30.00
Electrical
27.00
Plumbing
24..00
S.M.I.
84
Grading
Driveway Enc.
Infrastructure
t
TOTAL
" <t ,=` i ; %
REMARKS
_
skW'l4t': IA 3Y4'7X C,i-iIT)
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
1/12/90
Issued by: Date - Permit
Validated by:
Validation:
w
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL SO. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SO. FT. ®
TEMP. POLE
I
GROUT
DRAINAGE PIPING
CAR P. Sp. FT. ®
FINAL INSP.
WALL Sp. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
GRADING
cu. yd.
$ plus x$
=$
URINAL
SO. FT.
FINAL INS P11, / V
FRAMING
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
FIRE ZONE ROOFING:
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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% c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
HOUSE SEWER
FINAL INSPECTION
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 APPIEOUIP.
REIN F. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GFL
FINAL INS P11, / V
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUR611NITIALS
GARDEN WALL FINAL