06264 (RPL)Building
Address 52--040 Diaz
Owner
Fad Leoeau
Mailing
Address
,a
City Zip
?..?
Contractor
SV= Pools, Inc.
Address
68-300 RmoLt Road 96
Tjht 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City IZIp92234 ITe1.324-4460
State Lic. I city
& Classif. 421014 Lic. # 249
Arch., Engr.,
Designer
Address Tel.
City IZip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
e0gll) of Division 3 of the Business and Professions Code, and my license is in full fon and
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractors License Law for the following
reason: fSec. 7031.5,00siness and Professions Code: Any ray or county -- requites a
pe=rt to construct. alter, Improve, demolish, or repair any structure. prior to is 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 (conmincig with Section 7000) of
Dhision 3 of the Business and Professions Code, or that. he is exempt therein=, and the basis
for the aged exemption. Any violation of Section 7031.5 by any apprcarr for a permit
subjects the applicant to a civil penally or not more than five 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, Bisness 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 enpbyees,
provided that such inprovements are not intended or offered for sale. 0, however, the buildrg
or improvement is sold within one year of completion, the owner4midder will have the burden
of proving that he did not Mold or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project (Sec. 7044, Business and Professions Code: The Contractors License Law
does not apply to an owner of property who builds or improves thereon. and who contracts for
such projects with a contractors) licensed pursuant to the Contractors License Law.)
❑ 1 am exempt under Sec B. 8 P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to selFinsure, or a certificate of
Workers 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 if the permit is for one hundred dafas ($100) vakA ion
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: ff, after mating this Certificate of Exanphon you Sho kit become
subject to the %brkers' Compensation provisions of the Labor Code, you must hdhwlth
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lenders Name
Lenders 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.
1 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 lams 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. 06264
ILDING: TYPE CONST. OCC: GRP.;
1. Number 77;-212-002
Description
,t Description Pi?ol
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
Issued by: Date Permit
Validated by:
Validation:
Sq. Ft.
Size
No. No. Dw.
Stories Units
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
$10,000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
$76.0
Const.
117.00
Mech.
0+
Electricalz
*WC
Plumbing
24.00
S.M.I.
.70
Grading
Driveway Enc.
Infrastructure
it
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
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL Sp. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. Sp. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I Sp. FT.
GAS (FINAL)
TEMP. POLE
WALL Sp. FT.
DRINKING FOUNTAIN.
GROUT
WATER HEATER
URINAL
Sp FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
$ plus x$
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
CT
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, 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*/a c
SEWAGE DISPOSAL
SO.FT.GAR ® ?4c
HOUSE SEWER
MESH
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
-t 'I
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 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.
ROOFINGp7_/�
CT
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