12939 (RPL)TRY 4 4 a"
t P.O. BOX 1504 N O . 12939
Building 78-7955 Grayed Traverse�iT�', 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner Community Bank.
Mailing BUILDING: TYPE CONST. OCC: GRP. -
Address 100 East Corson Street.
A.P. Number
City ZipPT
el.
Pasadena, CA 91102-383 568tl-2083 Legal Description
ContractorPool and Spa
GJA. Pool Construction Project Description
Add=Ss65 Perez toad
CityZip Tel
Cathedral Cit!ra CA 92234 328-268&
State Lic. City
& Classif. C-53 275796 Lic. # 69 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTORS' DECLARATION
I hereby affirm that I am licensed under�proyrs o s of Chapter 9 (commencing with Section
7000) of Division . fof th,,e�,13 siinne'ss a d'P o essi6ii Code; army license is in full force and.
effect. t_'��h- .; ..
SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation$14,500.00
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 PERMIT AMOUNT
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 Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 105.30
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 162 alt
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 r 45.00 .
of proving that he did not build or improve for the purpose of sale.)
p 1, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 27.00
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 .S.M•1.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
❑ 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
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 Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
❑ Copy is filed with the city. 0 Certified copy is hereby furnished.
TOTAL 363.30
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if 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 ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Fron,t Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback fnPermit
ine
Lender's Name
Lender's Address FINAL DATE
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
1 certify that I have read this application and state that the above information is correct. ISSUed by: Dat
I agree to comply with all city and county ordinances and state laws relating to building. • 3 0 !
construction, and hereby authorize representatives •of this city to enter the above..mentioned property for inspection purposes. Validated by: Ion
Signature of applicant— Date l
Mailing Address Validation: y
City, State, Zip
1
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
1
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT.
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
AS (ROUGH G/
METER LOOP
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
F
GAS (FINAL)
TEMP. POLE
DRAINAGE PIPING
CAR P. SQ. FT.
GROUT
WATER HEATER
WALL S0. FT.
FINAL INSP.
DRINKING FOUNTAIN
SQ. FT. ®
WATER SYSTEM
FINAL INSP. �,
URINAL
ESTIMATED CONSTRUCTION VALUATION $
=$
WATER PIPING
NOTE: Not to be used as property tax valuation
VENTILATION
FLOOR DRAIN
MECHANICAL FEES
SPARK ARRESTOR
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
ep NAL INSPECTIO "'• t/
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
INSPECTOR'S SIGNATURESIINITIALS
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1114 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 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.
AS (ROUGH G/
METER LOOP
HEATING (FINAL)
OTHER APP.IEQUIP.
to
REINF. STEEL
F
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP. �,
FINAL INSP.
GRADING
cu. yd.
$ plus x$
REMARKS:
=$
LUMBER GR.
FRAMING
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
ep NAL INSPECTIO "'• t/
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Vii,-�f.;_�`y`•Ji iill� IUB 1J !iv(\lv+t .�tlLi it;'.vtiv.+ (i.J�Vv !•f;:: ;rV. U:O+ �JvJiJ • ;'; �4
K V -"
ICU
G.H. POOL CONSTRUCTION
P.O. BOR 399
CATHEDRAL CITY, CA 92235-0399
PHONE 328-2681
71-7 6o112,1