15525 (RPL)1
Addrdess 45-273 Desert Eagle
Owner T?aniel Tolharst
Mailing
Address sarae as above
City Zip
41.1 Quinta 1 92253
Pools, Inc.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Address .
77-550 Mountain View
City Tel.'
Palm'Deser 1Z�92211
345-0344
State Lic. City
& Classif. 310985 Lic. # 744
Designer
Address Tel.
City ( Zip ( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
if hereby affirm that I am Ucensed under provisions of Chapter 9 (commencing with Section
000) of Division 3 of the 18usine and P fessions Code, and rp license)s_in full force and
f4e%t / /��a w y
SIGNATURE / ' _ DATE
i
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's 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 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 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).
❑ 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
! 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
o/ 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 contractor(s) #tensed 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 1 have a certificate of consent to self -insure, or a certificate of
Worker's Comp cation Insurance, or a certified'oopy,thiareof. (Sec:r3800, Labor Code.)
Policy No. Company -�' -'wzy -/_�L
140 y is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) vatuation
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 California.
Date Owner
NOTICE TO APPLICANT. M, alter' making this Certificate o/ 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,
No. 15525
OCC. GRP.
Project Description Pohl and ,Spa
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New Q Add ❑ Alter ❑ Repair ❑ Demolition ❑
Valuation
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
134.55
207.00
24'.00
45.00
27.00
4:37.
ZONE: BY:
Minimum Setback Distances:
Front Setback from^Cent r�Line
Rear Setback from ear Prop. Line
Side Street Se k from Center LIl ee
Side Setbac r rom P,roperty Line K
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES
1ST FL. SO. FT. ® $
UNITS
SETBACK
GROUND PLUMBING
Y
ARD SPKLR SYSTEM
2ND FL. S0. FT. p
A.C. UNIT
COLL. AREA
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
BONDING
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
OR SEPTIC TA K
DRAINAGE PIPING
CAR P. SO. FT. ®
DUCT WORK
ROCK STORAGE
WALL SO. FT.
GAS (ROUGH)
DRINKING FOUNTAIN
SO. FT. ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
TEMP. POLE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
WATER SYSTEM
LAUNDRYTRAY
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.
SO. FT. RESID ® 1'A c
SEWAGE DISPOSAL
FIRE ZONE ROOFING
SO.FT.GAR ® 3/sc
HOUSE SEWER
FIREPLACE
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 i ELECTRICAL A HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMSSEWER
OR SEPTIC TA K
ROUGH WIRING
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 INSP.
ROOFING
I `
�t 1
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
.
GARDEN WALL FINAL