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10128 (RPL)' P.O. BOX 1504 No. 10128 Building 78-105 CALLE ESTADO l✓� Address 47-359 AIA KORGN LA QUINTA, CALIFORNIA 92253 C( 17 Owner DAVID LE©INS Mailing BUILDING: TYPE CONST. / / OCC: GRP. Address 69-838 $ROOKVIEW WAY A.P. Number City Zip Tel. CATHEDRAL CITY 132105845 Legal Description Contractor Project Description POOL/SPA/WATER FALL DODSON CONStRUCTION Address 68-805 A PEREZ RD. STE. E99 'City lZip Tel.: CATHEDRAL CI,Y 92234 324-1232 State Lic. City & Classif. 57$127 A Lic. # 1044 Sq. Ft. No. No. Dw. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7.6 by of Division 3 of the Business and Professions Code, and my license is in full force and Yeffect. SIGNATURE DATE \ , OWNER'BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following Z3®� 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 AMOUNT requires the applicant for such permit to file a signed statement. that he is licensed pursuant to PERMIT 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 clvil penalty or not more than five hundred dollars ($500)• Plan Chk. Bal.4152.10 ❑ 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 Const. Z34.00 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. 24.00 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.) Electrical 45.00 ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 27.U0 struct the project. (Seca 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.I. 2.30 such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) Grading ❑ I am exempt under Sec. B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent toaself-insurer a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec e3800, Labor Code.)` Policy -No. - .Company 1y L" �•-�c. Y , :16 o, py 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) valuation 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: 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 Ihereby affirm that there is a construction lending agency for the performance cf 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 Driveway Enc. Infrastructure 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 IST FL. SO. FT. ® = 2ND FL SO. FT. POR. SO. FT. ® GAR. SO, FT. ® CAR P. SO. FT. WALL SO. FT. ® SO FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE: Not to be used as property tax valuation' FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM. FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) 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 BOND BEAM - - J , SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Vi c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® V4c HOUSE SEWER �� /� I,/1j I (/ Yl �/l/ �/� / 1�/ 6 111 666 1 GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH_FEE PLCK.FEE CONST. FEE ELECT. FEESMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBINg1 f UNDERGROUND O L 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) i 1 / / ` l METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM - - J , WATER SYSTEM FINAL INSP. Mot (G FINAL INSP. D� L GRADING cu. yd. $ plus x$ _$ LUMBER GR. FRAMING ROOFING �� /� I,/1j I (/ Yl �/l/ �/� / 1�/ 6 111 666 1 GJ p CIP - REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING It FINAL INSPECTION- �C C CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL