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11384 (RPL)4 4- P.O. BOX 1504 No. 11384 Building 78-105 CALLE ESTADO Address 53760 MOHTEZURA LA QUINTA, CALIFORNIA 92253 Owner / ! GORDON HARTLEY BUILDING: TYPE CONST. OCC: GRP. Ma lIrly Address 53760 MONTEZUMA A.P. Number City Zip Tel.,, `,,,/ LA QUZLYTA 92253 ,/ J(O`1 �- ( Legal Description Project Description POOL AND SPA Contractor SWAB FOOLS Address 68300 RAMON CityZip Tel.: CATHEDRAL 4ZTY 92234 324-4460 State Lic. City &Classif. 421014 C-53 Lic.# 249 Sq. Ft. No. No.Dw. Size Stories Units Arch., Engr., New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑ Designer 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 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ` i 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,Business and Professions Code: Any city or county which requires a permit to construct, atter, 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 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 rive 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 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.) Estimated Valuation c Y 4 ��� PERMIT AMOUNT Plan Chk. Dep. Plan Chk. BBI. 7 A 9• 4 5 Const. 00 15 3.00 Mech. 24.00 Electrical - 45 •04 Plumbing 27.00 ❑ 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.) ❑ I am exempt under Sec. B. 8 P.C. for this reason S.M.I. •0 0 4 Grading Driveway Enc. Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy NO. -, o. Company f (Copy is filed with the city. O Certified copy is hereby furnished. f t� �' ti 'fit' 12(4 TOTAL • 5 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REMARKS (This section need not be completed N the permit is for one hundred dollars (5100) valuation or less.) I certify that in the performance of thq 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: N, 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. ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line 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 FINAL DATE Side Street Setback from Center Line Side Setback from Property Line INSPECTOR Lenders 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 car ity 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. Issued by: Validated by: Date Permit ' Signature of applicant Date Mailing Address Validation: City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ 2ND FL. SO. FT. ® POR. SQ. FT. ® GAR. SO. FT. ® CAR P. SQ. FT. @ WALL SQ. 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 ROUGH PLUMB. BONDING FLOOR DRAIN MECHANICAL FEES FORMS WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL y FURNACE UNIT WALL FLOOR SUSPENDED OTHER APPJEQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM GAS (FINAL) 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 FRAMING SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1% c SEWAGE DISPOSAL SO.FT.GAR ® 2/ic HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEESMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING Z7 UNDERGROUND 2 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) l METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INSP.cu. FINAL INSP. %, 4n GRADING yd. �$plus_x$ _$ LUMBER GR. FRAMING ROOFING �T p `,�]�` L L l// �tJ <,-e C --o,5 7e 7 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 -d