10146 (RPL)Building
Address
Mailing
Address
City,
P.O. BOX 1504 � �/ N Q .
78-105 CALLE
%979-3053079-305Desert Rock CS.rC�:e LA QUINTA, CALIFORNIA
9 92253 /y
'nom Haren
S Wine
Zip Tel.
LaQuinta I 92253 I
Contractor
Unique Pools by Carmine
Address I
74818 Velie Way #1
Palm Desert 192260
State Lic.
& Classif. C53 520432
Arch., Engr.,
Designer
Address
City l Zip
f' LICENSED
hereby affirm that I am licensed
A of Divisioh 3 of the Business
,1 346-6335
10146
BUILDING: TYPE CONST. OCC: GRP.:
P. Number
al Description
Project Description
POOL AND SPA
Lic' # 1366 I Sq. Ft.
Size
Tel.
State
Lic. #
IATION
er 9 (commencing with Section
d my license is in full force and
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's civil penally of not more than rive hundred dollars.(S500).
O 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. It, 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 ol'propertywho builds or improves 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 furnished:
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed 11 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
NOTICE -TO APPLICANT. If, 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.
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.
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
No.
Stories
No. Dw.
Units
I New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
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
a �
FINAL DATE
Issued by: Date
Validated by:
Validation:
INSPECTOR
Permit
Estimated Valuation
.815001
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
70.20,
Const..
103.00
Mech..
24.00 ,
Electrical t
` ' _ 45.00
Plumbing
','2 7. 00
S.M.I.
.90
Grading
,
Driveway Enc.
Infrastructure
TOTAL
REMARKS/ . ' �` .
.•' !• ' .
6::1 f:
A!:R+•i"+ a A A .x,s..: • .,
,. -� -• -ta e.•c q,
! Cfq 2=; t.a ,{ J,V l:d a{ iia S%
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
a �
FINAL DATE
Issued by: Date
Validated by:
Validation:
INSPECTOR
Permit
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. 5Q. FT. ® $
UNITS
SLAB GRADE
2ND FL 50. FT.
ROUGH PLUMB. BONDING
YARD SPKLR SYSTEM
POR. 50. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
FOUND. REINF.
DRAINAGE PIPING
CAR P. I 5Q. FT. ®
OTHER APPJEQUIP.
REINF. STEEL
WALL 50. Fi.
GAS (FINAL) TEMP. POLE
DRINKING FOUNTAIN.
5Q FT ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
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
REMARKS:
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.
SQ. FT. ® c
BATH TUB
SQ. Fr. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4C
HOUSE SEWER
MESH
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACKGROUND
PLUMBING/�1NDERGROUND
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) /AC /1 , L METER LOOP
/ 'L
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.
FINAL INSP. �� q(�
FRAMING
FINAL INSP. 1 a
ROOFING
n
r(,) 11 1x11 !0 ;-
J
rA
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTIOtt F' % _I / LP
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL