06224 (RPL)Building 54-865 Inverness
Owner
Palo.
Mailing
Address
City lZip
T4ht 4
P.O. BOX 1504 No.
78-105 CALLE ESTADO
-«LA QUINTA, CALIFORNIA 92253
Contractor
Ca-ufornla,Pools' 6 5pgs'.
Address . «.'
61•-910 Boardwalk
City lZip I Tel.:
06224
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number FG;A West
Legal Description
Project Description swlribnpr r-401 & sna
State Lic. City
& Classif. 1 Sit Lic. # $
Arch., Engr,
Designer
Address Tel.
silty I ZipI State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
effect
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
'
SIGNATURE DATE
OWNEWBUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractors License Law for the following
recta: (Sea 7031.5,8usihess and Professions Code: Any city or county which requires a
permit to eruct. ata, irprove, dertaGsh, or repair any structure, prior to its issuance. also
regies the- for such pemuT to Me a signed statement that he is licensed pursuant to
the Pn*** s at the Contractors license Law, Chapter 9 (commencing with Section 7000) of
4vision 3 of Me Ousbess and Professions Code, or that. he is exempt therefrom, and the basis
6 `tor the waged exemption. Any violation of Section 7031.5 by any applicant for -a permit
subjects the appira Ito a circ penally of not more than five hundred dollars (8500).
❑ 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, Suisness and
`L Professions Code: The Contractors License Law does not apply to an owner of property who
binds or implores 0herean and .who does such work himself or through his own employees,
provided Ihat such irprovements are not intended or offered for sale. If, however, the building
Z;or irprova ent is sold w8hn one year of comptetion, the owner -builder will have the burden
of proving that he dd not builder irprove 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 Contractor's License Law
does not appy to an owner of property who builds or improves thereon, and who contracts for
such projects with a conbacor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. - B. fi P.C. for this reason
Date owner.
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Poling NO. mpany
❑ Copy is filed with the city. . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE '
(nils section need not be cdrpleted if the permit is for one hundred dollars ($100) valuation
or less.) ..
1 certify that in the performance of the work for which this permit is issued, I shall not
employ,any pe+son in any manner so as to become subject to the Workers' Compensation
Laws of California
Date Owner
NOTICE TO APPLICANT: U, after making this Certificate of Exemption you should become
subject m the Workers' Conpersatkn provisions or the Labor Code, you must forthwith
campy white such Prov -aids or this Permit shalt be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CIO Code.)
Lenders Name
Lenders Address
This is a building permit when property filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 100 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
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center Line
Sq. Ft. M.
Size -
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
FINAL DATE
INSPECTOR
Issued by:
Date x/29%89 Permit
Validated by:
Validation:
Estimated Valuation
$24,000
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
9134.55
Const.
207.00
Mech.
30.01)
Electrical
27.00
Plumbing
24.00
S.M.I.
1.40
Grading
Driveway Enc.
Infrastructure
TOTAL
_ e_
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 x/29%89 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS'
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CARP. SQ. FT. ®
GAS (FINAL) ] b
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
SQFT®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
,
FLOOR DRAIN
MECHANICAL FEES
GRADING
cu. yd.
plus x$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
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.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B_T.U.
SQ. FT. RESID ® 11/. c
SEWAGE DISPOSAL
SQ.FT.GAR ® V4c
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
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
D PLUMBIN &
UNDERGROUND l V fs
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL) ] b
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
_$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING:gQ
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION- i
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESANITIALS
GARDEN WALL FINAL