10917 (RPL)~ P.O. BOX 1504 No. 1091.7
7&105 CALLE ESTADO:
Addrress 54-371, Southern' HilIS` LA QUINTA, CALIFORNIA 92253.
,. Owner ,
Haim Van messell
Mailing. BUILDING: 'TYPE CONST. OCC: GRP.
Address 13503 Cheltenham Dr. A.P. Number
City Zip Tel.
r
She+r$n Oaks 91423 Legal Description
Contractor k
Project Description
Ca1lfornia Pools and Seas ,Pool.and Spa'
Address . _
41910 Boarftalk #A2
' City '
Zip
SIGNATURE DATE
Tel.:
Palm
92260
Estimated, Valuation
340
State Lic.City
&.Classif. ' C5 1851.02
reason: (Sec: 7031.5,Business and Professions Code: .Any city or county which requires a
Lic. #
Arch., Engr:;
permit to construct, alter• improve, demolish, or repair any structure; prior to its issuance - also
Designer. •,
PERMIT '
Address
r
Tel.
z_
. for the alleged exemption. Any.; violation•'of Section .7031:5•-by-'any'applicant_for a permit ..
Plarl.Chk. Dep..
. -City
Zip
O I, as owner. of the property, or my employees with wages as'their sole compensation; will
State
'
- do the work; and the structure.isnot intended otoffered for -sale. (Sec.' 7044, Buisness and
• Professions Code: The Contractor's License,Law does not apply to an•owner,of, property who
Lic. #
LICENSED CONTRACTOR'S DECLARATION
Lherebyafficmrthat,l am -licensed underurovisions of Chapter 9 (comrt
355 Sq., Ft. No.
Size -- Stories
I New ❑ . Add ❑ :. , Alter ❑
Units
Repair ❑. Demolition`❑
1.4.000
AMOUNT
99A5 '.7.
153.00'.
24.00-
45.00-
27.00
4.00.45.00.27.00
Date Owner
Infrastructure
SIGNATURE DATE
OWNER -BUILDER DECLARATION
_ •,
Estimated, Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the.following-
'" I hereby 'affirm that I have a 'certificate* of* consent to self -insure, or a certificate of.
Worker's.Compensationlnsurance,.ora.certified.copythereof.:(Sec:3800,.Labor.Code.).. -
reason: (Sec: 7031.5,Business and Professions Code: .Any city or county which requires a
'
.. Policy No. .Company '.
permit to construct, alter• improve, demolish, or repair any structure; prior to its issuance - also
requires the applicant for such permit to foe 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
r
` "Division 3 ofthe Business and Professions Code, or. that. he is exempt therefrom, and the. basis .'
z_
. for the alleged exemption. Any.; violation•'of Section .7031:5•-by-'any'applicant_for a permit ..
Plarl.Chk. Dep..
•' subjects the applicant to a civil penalty of not more than five hundreddollars,($500). ' '
-
Plan Chk. Bal.
O I, as owner. of the property, or my employees with wages as'their sole compensation; will
Const.*
- do the work; and the structure.isnot intended otoffered 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,.-
•. Mech..; •-
- 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. '•
Electrical- '
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con,
Plumbing
• struct the -project. (Sec: 7044,1- Business and Protessions'tCode: The Contractor's License Law
k. 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.) -
NOTICE TO APPLICANT: If, -after making this Certificate' of Exemption you should' become '•
'Cornpensafiob'
I
Grading
O lam exempt under,Sec. _ B..& P.C. for this reason
Minimum Setback Distances:-��~•-v..� - '
r
Driveway Enc.
1.4.000
AMOUNT
99A5 '.7.
153.00'.
24.00-
45.00-
27.00
4.00.45.00.27.00
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.Compensationlnsurance,.ora.certified.copythereof.:(Sec:3800,.Labor.Code.).. -
'
.. Policy No. .Company '.
s e� y� fY .g, z x; .z
�� V �s.�4.'t"` "" j,+.4:i+�`.'r�S' J'Jr��Y�I_; •2, i� _149.:�-49`r E•
Copy is filed with the city. O Certified copy is hereby furnished.. '.
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TOTAL
.349.85
CERTIFICATE OF EXEMPTION FROM
REMARKS
• .., WORKERS' COMPENSATION INSURANCE'
.- (This section need not be completed if the permil•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 persomin any manner so as to become subject to the Workers' Compensation'
Laws of Cald0 nia.
' 'Dat- " Owner
NOTICE TO APPLICANT: If, -after making this Certificate' of Exemption you should' become '•
'Cornpensafiob'
ZONE:
" BY:
_ subject to' the •Workers' provisions of. the Labor. Code, you must forthwith
comply with such provisions or this permit shaft be deemed revoked.. ' -
Minimum Setback Distances:-��~•-v..� - '
Front Setback from Center Line
Rear.Setback from Rear Prop. Line '
CONSTRUCTION LENDING AGENCY-
'a
Side Stfeet Setback from Center Line
I hereby affirm that there isconstruction lending agency for the.performance of the
work'.for which.this permit is issued. (Sec: 3097,'Civlt Code.)
Side Setback from. Property Line '
Lender's Name
-
Lender's Address
FINAL DATE
INSPECTOR
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 certify that I have read this application and state that the above information is correct.
Issued by.
Date Permit
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. '.
Validated by:
Signature of applicant Date
Mailing Address
Validation:
-
City, State, Zip
N s
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
2ND FL SQ. FT.
BONDING
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CARP. SQ. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SQ. FT.
OTHER APPJEQUIP.
DRINKING FOUNTAIN.
SQ 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.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FRAMING
GARBAGE DISPOSAL
FURNACE UNIT WALL . FLOOR SUSPENDED
J(/��
LAUNDRY TRAY
AIR HANDLING UNIT CFM
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.
SQ: FT. RESID ® 1Vi c
SEWAGE DISPOSAL
LATHING
SQ.FT.GAR ® 3yic
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE -
MECH.FEE PLCK.FEE
= JELECT.FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
OUND PLUMBIN057/qqe
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.
� y
E NAL INS l/
I
FRAMING
FINAL INSP.
ROOFING
J(/��
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL