9992 (SFD)Buildin
Address 52-'980 Obregon
Owner
Shelley C. Barber
Address 6160 D 4 Arlington 4126
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
City Zip Tel.
Riverside. 92504 1714/684-701
Contractor
xoectation Cares t4ruc;tion
54360 Martinez
Zip
La Ouinta I
9225
State Lic. City
& Classif. B 613406 Lic. # 1850
Arch., Engr.,
Designer
Address Tel.
City (Zip( State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
i 1 hereby affi m that I am' licensed under provisionsof Chapter 9 (commencing with Section
117000)of
Division 3 of the Business andProfessions Code, and my license is in full force and
fectNATURE' Z' 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, 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 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 penally of not more than rive 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, Buisness and
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,
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 bnprove for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-.
Strutt 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 contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
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
YCopy is filed with the city. ❑ Certified copy is hereby furnished. .
CERTIFICATE OF EXEMPTION FROM
WORKERS'COMPENSATIONINSURANCE
(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. 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.
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 Address
City, State, Zip
(BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
,Legal Description
Project Description
SFb
Sq. Ft. 1696 No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
NOTE. CHANGE OF COINTEMCTOR ONLY; this
PERKIT ,REPLACES PF.RPUT 9669
Estimated Valuation
1.12,678.80
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Meth.
Electrical '
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL N / C
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:
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR SO FT ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT.
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPlEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation'
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
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, TEMIPERM
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 ® 1% c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3Ac
HOUSE SEWER
LATHING
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
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPlEOUIP.
REINF. STEEL
GAS (FINAL)
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
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESHNITIALS
GARDEN WALL FINAL
t•: .i
INSTALLATIOMCERTIFICATE
Pool' And Spa Heatin `S stems
Site Address-
%i /
a;
titorcement Agency:- Perm
p Ll t';JN - „ is
Pool•.and Spa Heating;SysterAs requirements
§114(a) Systcros and`Equiptnent �.
❑;., I Heater,has'a thermal efficiency that complies with lie Appliance Efficiency Regulations. ` 4,
Os 2 qi s.a-read ily accessri°ble on-off switch mounted outside of the,heater.. `
3 Weatherproof pla(e or card containing operating instriictions for the,pool or spajheater.
4. No electric resistance heating except for listed'package units that h s�fully insulated enclosures and tight fitting;
covers that are insulated to at least R-6. Of if documentation is provided that at least 60 % of the annual heating
energy is from site solar energy or recovered energy.-.-
5..
nergy.5.. Heating system has no pilot light. '
§I 14(b): Installation.
❑ 1. System is installed with at least 36" of pipe between- thetilter.andheater;;or dedicated suction and retur►:dines,
or built-in or built-up connections for fuiit; `solai-heattng:
V s,
r ❑ 2. A cover for outdoor pools. or spas that'have�a heat pump'or,gas heater:-
_ 3: Pool system has directional inlets to adequately mix4he pool water_
❑ ;.
❑_, 4. Time switch which will allow the pump be set or„progra” ' ed to�run during off --peed periods only
§150(p)�PumpsSizing and flow rate specitieatioii` tz E
13' 1 The pump, specified is listed in the,CEC database of certified pool pumps.
❑ 2. The pflow rate shall be cal culated based on pool sizing table below. s�
❑ 3. The pump is capable of operating at 2 or more speeds (not'applicable if pump, is less than 1 horsepo�xrt)
❑ 4. Each auxiliary pooPload is served by either a�separate pump, or die'systern as�served, by a multi-speed'pump:
t
Pool sizins, N91nlQ am h'cM nn n mo�imum ollnvruhtw` tuennvwr r.4� nf.IC: hnurQl'r®'
Max Pool.'
❑
Volume
�.
Min Pipe
D or. Greater,1 '1Min Filter Area or moor
Max Pumpm
(gallons)inches.
(gallons);,,_
�
5„ ' s uaie
low
'
Return
Suction Cartridge, . Sand ' DE
' r_
13,000
1.5
=' l .V14- 100 ''V ' 2.4 , ;20
'' ' ' `36
17,000'
1.5
2 f30 ='3.1 - 25 '
zj
r.?, . 4.. 47,=:
21,000
2
�z 2 .h l'60� . ;-3:9'30
28,000
2
2.5 : r 210. 'S:2, * `;x`,40
78
42 000
2.5-
3 330,x... ' ' .7,8 „ �.�.
a{ 117
48,000
.3,
-3 '.'"`" 3'60'-;_`,% :. '8'.9 170
Note: For pumps -greater thin 1. hp. The tnax1Miiam,Pump Flow is,the lowest speed:defaalt filtration
❑
5.; Calculated %DSO,'
J �
volume of pool,
(gallons);,,_
❑
6. Return Pipe Diameter S
(inches) A,,yyk
❑
7. Suction Pipe Diameter 2 S}���-1 r1 r. ; .
x
(inches)... : t
❑
8. Filter Type Z
(Cartridge, Sand, DE).
D.
9.' Filter•Surface Area --2— 2—
Of
10. Max Pump Flow �� '`
(gPm)
jl ..
2008 Residential Compliance_,;Forins August 2009
INSTALLATION CERTIFICATE CF-611-MECH-03
Pool And Spa Heating Systems (Page 2 of 2
Site Address: Enforcement Agency: Permit Number:
System Piping
O 1. The suction side pipe is straight for at least 4 pipe diameters before entering the pump (See table below for the
required straight run lengths for various pipe sizes).
Ll 2. The design uses low pressure drop fittings (sweep90's)
Pipe Diameter
inch
Required Pipe Length
leading into pump (inch)
1.5
6
2
j ..
2.5
�C
.3
12
INSTALLATION CERTIFICATE CF-611-MECH-03
Pool And Spa Heating Systems (Page 2 of 2
Site Address: Enforcement Agency: Permit Number:
System Piping
O 1. The suction side pipe is straight for at least 4 pipe diameters before entering the pump (See table below for the
required straight run lengths for various pipe sizes).
Ll 2. The design uses low pressure drop fittings (sweep90's)
Pipe Diameter
inch
Required Pipe Length
leading into pump (inch)
1.5
6
2
g
2.5
10
.3
12
Filtr2tiob Equipment
O 1. if 4 backwash valve is used: The diameter of the backwash multi -port valve is 2 inches or as large as the
circulation pipe, whichever is greater
DECLARATION STATEMENT
"\ I certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
• 1 abYeligible under Division 3 of the Business and Professions Code to accept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
• 1 certify that the installed features, materials components, or manufactured devices identified on this certificate (the installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and specifications approved by the
i
enforcement`agency.
• I reviiwed a copy of the Certificate of Compliance (CF -IR) form approved by the enforcement agency that identifies the specific
• requirements for the installation. I ccrtify that the requirements detailed on the CF -IR that apply to the installation have been met.
• 1 will ensure that a completed, signed copy of this Installation Certificate shall be posted, or made available with the building
permit(s) issued for the building, and made available to the enforcement agency for all applicable inspections. I understand
Y•,
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to
the building owner at occupancy.
2008 Residential Compliance Forms
August 2009