9719 (RPL)P.O. BOX 1504 N O . 9719
Building 78-105 CALLE ESTADO
Address 78-380 Ura Sevilla LA QUINTA, CALIFORNIA 92253
Owner
Johnsen BUILDING: TYPE CONST.. OCC: GRP.
Mailing
Address. same
A.P. Number
City Zip Tel.
4ja Quinta 92253 Legal Description
Contractor Project Description
Allied Pools
Address Pati, &ND SPA
4358Q ,Paimilla
City Zip Tel.: "
Palm Desert 1 92.260 340-5474
State Lic. City
& Classif. Lic. # S Ft. No. No. Dw.
C53 542660 sze - - 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 Chaple'r 9 (commencing with Section
-7000) of Division 3 of the Business and Professions Code„and.my4icense is in full force.and
r
SIGNATURE - DATE
OWNER-BUILDER DECLARATION” Estimated Valuation`
I hereby affirm that I am exempt from the Contractor's License Law for the following 18000.00
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 rile a signed statement that he is licensed pursuant to PERMIT
the provisions o/ the Contractor's License Law, Chapter 9 (commencing with Section 7000) o/
' Division 3 of the' Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation o/ Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
..subjects the applicant to a civil penalty of not more than rive hundred dollars.($500). - -
0 I; as owner of the property, or my employees with wages as their sole compensation, will . Plan Chk. Bal. 122.85
;.do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and Const. 187.00
.
'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 o/ completion, the owner-builder will have the burden Electrical ,, • �� .
of proving that he did not build or improve for the purpose o/ sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to coo-.. Plumbing 27.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law iw
does not apply to an owner of property who builds or improves thereon, and who contracts for .S.M.I. .
190
.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
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 7 " , fL-' i ' ll is 3 ,[fia• 3 C't 7 R
Copy Is filed with the city. . ❑ Certified copy is hereby. furnished. �'t - i.A �r EAf -
TOTAL 407:65
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 o/ the Labor' Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked. -
Front Setback from Center Line '
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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.
I'cerlify that I 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
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT.
ROUGH PLUMB.
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
ROCK STORAGE
DRAINAGE PIPING
WALL SO. FT.
METER LOOP
DRINKING FOUNTAIN.
SO FT ®
REINF. STEEL
URINAL
ESTIMATED CONSTRUCTION VALUATION $
TEMP. POLE
WATER PIPING
NOTE: Not to be used as property tax valuation
GROUT
FLOOR DRAIN
MECHANICAL FEES
SERVICE
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FINAL INSP.
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 ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAR. FIREWALL
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
Lr UNDERGROUND
$ q 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 1 a (L
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
a
( t/GS
&�Ic(67�(
l [/ /
REMARKS:
VENTILATION
FIRE ZONE ROOFING :
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION- L
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL