15772 (RPL)_
Building
AO,drl3ss 79-240 Kara Cwt.
Everett & Virginia Perry
Mailing
Address 79-240, Kara Ct..
City Zip Tel.
La Qu nta 92253
Contractor Sunrise Po63l$
Address
P.b. box 12573
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.:
Palm Desert 92255 3410-5512
State Lic: City
& Classif. 556236 . Lic. # 1604
Arch., Engr.,'
Designer
Address Tel.
City IZip I State
#
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 f ti t ry ri dry+ - C— T d.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Thereby affirm that I am exempt from the Contractor's License UW for the following
reason: (Sec. T031.5,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 file 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 vkNatlon of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ .l, 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 Contractors. 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.)
❑ 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
such projects with a contractors) lcensed pursuant to the Contractor's License Law.)
O 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. d �mpany
0-yiCCops filed with the -city.. ❑ Certified copy is hereby furnished.
or
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE "
(This section need not be completed if the permit is for -one hundred dollars Is 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
NOTICE TO APPLICANT. N, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND .
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION.TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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.
1 certify that 1 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 Address
City,/ State, Zip
1 _
No. 15772
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description 'Poo a 'S,a,
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft.
Size
No. No-.Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ -Demolition ❑
FINA E�
INSPECTOR
!
y
Is Lied by:
Date Permit
-Validated by:
Estimated Valuation
;11 rr 000.00
PERMIT
AMOUNT -
Plan Chk. Dep.
Plan Chk. Bal.
81.90
Const-
$126.00
Mech.
f 24.00
Electrical
$ �dt' 5 ,'00
Plumbing
$ 27.00
S.M.I.
Grading
Driveway Eric.
Infrastructure
TOTAL
REMARKS
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
FINA E�
INSPECTOR
!
y
Is Lied by:
Date Permit
-Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIW FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO. 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
-110V
FLOOR DRAIN
MECHANICAL FEES
STORAGE TANK
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FOUND. REINF.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
HEATING (FINAL) .
LAUNDRYTRAY
AIR HANDLING UNIT CFM
GAS (FINAL)
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
LUMBER GR.
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
f 11
SO.FT.GAR ® V4c
HOUSE SEWER
VENTILATION
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' ZTRICAL HEATING & AIR COND. SOLAR
0
SETBACK
GROUND PLUMBING
UNDERGROUNDA.C.
UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
-110V
I BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPI
EANKJROUG IRI
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL) .
OTHER APPJEOUIP.'
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 IN
ROOFING
f 11
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION G
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS.
GARDEN WALL FINAL
P/L
E118AN TIENT LIVE
30' '.
I
3' � \
P/L
.r.
I'
r
DECKING
EXISTING ' KE5VENGE
POOL EOL IP, 7q-240, KAKA GT.
LA QIJNTA, GA
(o
P/L
G ►L SmawAmi
POOL SIZE 15"30
POOL AREA 378 SO. FT-
I DEPTH 3'6' TO 4IF -7 - I
TILE CHOICE
GROUP II
POOL CAPACITY
APP. 10,000
GALS.
PUMP CAPACITY
90
GPM
POOL PUMP
1.5 ULTRA PLO
HP
FILTER
QUANTUM 175
SOFT.
FILTER RATE
175
GPM
VAC/SKIMMER 1 i/2 / 2 N.
RETURN LINE I IN.
MAIN DRAIN ANTI VORTEX
I SKIMMER MODEL DUAL PORT 1
HEATER TELEDYNE 250,000 BTU
GASLINE BY: 5UNKI5E LENGTH 100 FT.
LIGHTS -POOL 400 WT. SPA 100 WT.
TIME CLOCK NTEKMATIG 24 HR.
ELECTRIC BY: 5UNKI5E BONDING 5UNK15E
POOL CLEANER N/A
CHLORINATOR N/A
DIVING BOARD N/A
LADDER N/A
SLIDE N/A
ROPE RINGS N/A
ACCESS TRACTOR
GRADING NONE STUB PLUMB NO
DECKING SUNRISE SO, FT. 750
CONCRETE REMOVAL BY: NONE
RAISED BEAM -LENGTH N/A HEIGHT
SCALE I'- 8' DRAWING #
EVEKETT AND VIKGINIA FEKKY
7q-240 KAKA GT.
-A QUINTA, GA
6L
-
SUNRISE POOLS PALM DESERT, CA.
CALIFORNIA LICENSE 146. C53-556236
APPROVED BY
THS DRAWING PJ POOLS l ,
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