04317 (CP)T4'ht 4 4 Q"
Building
' t
Address
Owner
, sunxis ► compan
Mailing
Address 75-005 Country
City Zip
Palm Desert 92260
Contractor
G &--.4 Pool cnnstructi
Address
E8-1665 Pares R04d
City lZip
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
0 403 17
BUILDING: TYPE CONST. OCC. GRP.
.Ltd Drive A.P. Tel. Number �EY�3 Wsk-Af
_ .. _.
�Sa-:2 Legal Description
Project Description 4"Pool �� 573an
M y I
State Lic.
& Classif. 295796
City
Lic. # 69 _
Sq. Ft. No.
Size Stories -
No. Dw.
Units
Arch., Engr.,
Designer
New ❑ Add ❑ Alter ❑
Repair ❑ Demolition ❑
Address
Tel.
'
employ any person in any manner s0 as to become subject to the Workers' Compensation
Laws of California.
City
Zip
State
Lic. #
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
ZONE: BY:
LICENSED CONTRACTOR'S DECLARATION
I hereby.affirm that,l=am licensed under proyisions,ofChapter 9 (commencing with Section
7000).of Divisiion,3 of the?Business and,Profess'ions Code, _let
license is in full force and ,
effect.,; ✓+�`/`, �.":, rs? w,. .s .. ,--. / �+., r� ?. �f
Minimum Setback Distances: '
Front Setback from Center Line
SIGNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Buslness and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, per 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 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, 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
of proving that he did not build or improve for the purpose of sale.)
0 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) licensed pursuant to the Contractor's License Law.)
0 1 am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
$20#000
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.)
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
5y,,,�, �t
•1- •,3 Z
Const.
JAU • ':)U
Mech.
1b • (A)
Electrical
Plumbing
S.M.I.
1 .47
Grading
Driveway Enc.
Date Owner
Infrastructure
WORKERS' COMPENSATION DECLARATION
Thereby affirm that I have a certificate of consent,to'self:insure, or a.certificate of
Worker's Compensation Insurance, or a certifiedreopy thereof. (Se6`:u3800,.Lab_ _or Code.)--......._,
Policy No. Company
❑ Copy is filed with the city. O Certified copy is hereby furnished.
.,..t
_
TOTAL
CERTIFICATE OF EXEMPTION FROM
REMARKS tr
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
1 certify that in the performance of Ing work for which this permit is issued, I shall not
'
employ any person in any manner s0 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
comply with such provisions or this permit shall be deemed revoked.
Minimum Setback Distances: '
Front 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 from Property Line
Lender's Name
Lender's Address PECTOR
This is a building permit when properly filled out, signed and validated, and is subject to FINAL DATE IN ��3
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
WHITE - FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLDENROD - ASSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL SO Fl (p $
UNITS
SLAB GRADE
ROUGH PLUMB
BONDING
YARD SPKLR SYSTEM
2ND FL SO FT. @
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR SO FTat
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GARSO. FT.
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SO FT, (a'
FINAL INSP.
WALL SO. FT. til
WATER SYSTEM
DRINKING FOUNTAIN
GRADING
cu. yd.
$ plus z$
_ $
URINAL
SO FT (p'
FINAL INSP.
FRAMING
ESTIMATED CONSTRUCTION VALUATION S
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
FIRE ZONE ROOFING
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
FIREPLACE
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 V. c
SEWAGE DISPOSAL
SO.FT.GAR r 3/,c
HOUSE SEWER
FINAL INSPECTION
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.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus z$
_ $
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
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
Page _ of � ^I
tti DAVE STEAVENS
Inspection Services
PROJECT G LJ C 5'1'• L t G> �`y Q PROJECT # P00,0 - 0 4
ADDRESSS'l. 761; 74,7q�?!!Y
• f`ii�� tarv�' 1��. �3 t �ia•� s'.
BLDG. PERMIT #
ENGINEER�)WJ) SSA&W9 iAJP_-
INSPECTION TYPE
CLIENT PC*i4 uj C s 7" 'w` f %o4
.DATE dA .7"uLq Po�2
ARCHITECT 6; b CH
CONTRACTORJ)e't /1"444 PAC ► r o r,
INSPECTION REPORT
t C`r*s%_5►-- !. 4?15. 7- Plock sj& A •3at.`s
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%4;4A ILS - 7 — L' 9r� s A to c 14, 14) C., � #4 -31; • Cos. Qjcrc.
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D6 rA'+t..—/)'/s•"I 1** 50l1•.7 A `t- wtS*rA,A3
+ �1 - "� ' #a+,'� t� . t.rzu �.�1 •3�' r L. Pi �r 4.7y; s�».,3tcrc-
CERTIFICATION OF. COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially complies with'approved plans, specifications and applicable sections of the building codes. This report covers
ations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. 0 CT. S-43 Y TI 574
DATEAA X4A4L"1 01420 Z
INSPECTOR NAMEJ C ' J r ✓��
INSPECTOR SIGNATURE