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003324 (RPL)1 • 44.AV P.O. BOX 1504 Building55-840 P BIX BACHLA QUINOTA, CALIFORNIA 92253 Address Owner marling Address 55—$40 PEBBLE REACH City Zip Tel. LA ;�iiXNTA 92253 Contractor PATRICK Z*' PENLBY Address No: .003324 BUILDING: TYPE CONST. OCC: GRP. A.P. Number Legal Description Project Description POOL AND Mia SPA P.O. BOX 1553 BY: Minimum Setback Distances: City- PAW1 DRSEI Zip T 92263 Tela 346-1469 Rear Setback from Rear,Prop. Line State Lic. & Classif. C53—C10 335358 City Lic. # �-, Sq. Ft. Size No. No. Dw. Stories Units Arch:, Engr.; Designer New [W$ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. City Zip State Lica#. . . LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9'(commencing with Section 7000) of Division 3 of thhe••Business•and Professions Code, and my license is in full force and effect ) _.te' � ' . %. � Y SIGNATURE —' —.t---. � � � -- - "f' DATE \,OWNER•BUILDER DECLARATION' I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Seo,. 7031.5,Business and.Professions Code:. Any city or county which requires a permit. to construct, after, improve, demolish, or repair any structure, prior to its issuance also - requires the applicant for such permit to rile a signed statement that he is licensedpursuant 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 theirsole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, auisness and Professions Code: The Contractor's License Law'does not apply to an owner of property who builds or knproves 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.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- -. 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.)- ❑ I am exempt under .Sec. B. 8 P.C. for this reason Estimated VdlUatlOfl Y t� i.i • - PERMIT - AMOUNT Plan Chk..Dep. - -• Plan Chk. Bal. 641. I2 Const.,i ©, .50 Mech. 16.00 Electrical 20.00 w Plumbing! 0struct S,M;I. - Grading 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 f]�Copy is filed with the city. ❑ Certified copy is hereby furnished. �'4 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.) - A - 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 V-- " '-I: Owner �'-" •✓' �. TOTAL 203.43 REMARKS (i11�}{ �7. fj [•fir,_ (}f' -?�f ^> 1 i ' NOTICE TO—APPLICANT: If, 'alter,making 'this Cerfiricate- of-' Exemption you should become subject to the Workers' Compensabonfprovisions of ' the Labor Code;wyou-'must forthwith comply with such provisions or this permti shall 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, 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 it 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 ate Mailing Address City, State, Zip HARD COPY 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%?ill3Fermit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES .� 1ST FL. SQ. FT. ® $ 2ND FL. SQ. FT. POR. SQ. FT. ® GAR. SQ. FT. ® CAR P. Q. FT. WALL SQ. FT. ® SQ. 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 BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP.IEQUIP. LAUNDRYTRAY AIR HANDLING UNIT CFM TEMP. POLE 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 ® 11/4 c SEWAGE DISPOSAL SQ.FT.GAR ® 3/ac HOUSE SEWER REMARKS: VENTILATION 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 L FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP.IEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ -Plus-X$-=$ LUMBER GR. INAL INSP. Z� �f/7 FRAMING FINAL INSP Z- 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 SIGNATURESANITIALS GARDEN WALL FINAL