RPL (12-1030)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/07/12
Application Number: 12-00001030 Owner:
-Property Address: 57061 MERION NICHOLS TERESA & BOB
`APN: 762-031-008- - 57061 MERION �^
Application description: POOL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL IUI
Application valuation: 38000 �<?'
!EP 18 I�
Contractor: _
Applicant: Architect or Engineer: PLATINUM POOLS & SPAS IN IINT"
n �IiY bF LA �L
78310 AVENUE 41=!�AMCEnEn
BERMUDA -DUNES, CA 9220.3"'
(760)345-8333
Lic. No.: 965236
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
- rI hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License C ss: C53 - nse No.: - 965236 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
/Dater?I� Contractor: L �GtX-C . - I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION- _ insurance carrier and policy number are:
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the - Carrier STATE FUND` Policy Number 1863573-2012,
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions -of the Contractor's State and agree that, if f shout become subject to the workers' compensation provisions of Section
License -Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 0 of he Labor Co , 1 shall forthwit omply with th a provisions. .
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
OIL,
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: pplicant: 'G>(%ua w ✓�iJ
(_ 1 1; 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, Business and Professions Code: The WARNING: FAIL RE TO SECURE,WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. 'if, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. - - -
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed_ 1 . Each person upon whose behalf this application is made, each person at whose request arid for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , 8.&P.C. for this reason the owner, and the applicant, each agrees to, and shall. defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit. '
Date: Owner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 day r will subject
CONSTRUCTION LENDING AGENCY permit to cancellation.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to c mply with all
work for which this permit is issued (Sec. 3097, Civ. C.)• cit and county ordinances and state laws relating to buildinRSWZ
y authorizer resentatives
of his cou ty t enter up - n the above-mentioned property
Lender's Name: '
ate!?/ (/ Si azure (Applicant or Agent):
Lender's Address:10
LQPERMIT
• Application Number 12-00001030
Permit . . . MECH POOL '.
Additional desc
Permit Fee 26.00. Plan Check Fee
6.50
Issue Date Valuation .'. . .
0
Expiration Date 3/06/13
_ Qty' Unit Charge Per
Extension
y M•
BASE FEE
15.00
1.00 11.0000 EA MECH FURNACE >100K
11.00'
Permit ', .,.BLDG POOL PERMIT
Additional desc
Permit. Fee' . . 336.50 Plan Check Fee
218.73
' Issue DateValuation
38000 '
Expiration Datec. 3/06/13
Qty Unit Charge Per.
Extension
BASE FEE
252.00
13.00 6.5000 THOU BLDG 25,001-50,000
-----------i---------------------------------------------------------------_
.84. 50
Permit ELEC POOL PERMIT -RES
• Additional desc
• Permit Fee 45.00 Plan Check Fee
11:25
Issue Date Valuation
0
Expiration Date 3/06/13
Qty Unit Charge Per
Extension
- BASE FEE
15.00
1.00 ', 30.00001EA ELEC PRIVATE SWIMMING•POOL
-.------------ :------------- ---------- .----------------- -i--------------
30.00
' Permit PLUMBING
Additional desc .
Permit Fee 33.00 Plan Check Fee
8.25
Issue Date . . . Valuation . . . .
0 '
Expiration Date .3/06/13
Qty Unit Charge -Per
Extension
BASE FEE '
15:00
2..00 6.0000 EA PLB FIXTURE
12.00,
1'.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000 EA PLB GAS PIPE 1-4"OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
POOL. ALARMS/BARRIERS SHALL BE IN PLACE
_
y
LQPERMIT -
Application Number
. . . . .
12-00001030
Special Notes and
Comments
AT PRE -PLASTER INSPECTION.
EQUIPMENT
ENCLOSURE NOT INCLUDED.
2010
CODES.
-----------------------------
Other Fees .
----------------------------------------
. . . . .
BLDG STDS ADMIN (SB1473)
--- --
1.00
Fee summary
Charged
Paid
Credited
Due .
Permit Fee Total
440.50
.00
.00
440.50
Plan Check Total
244.73.
.00
.00' _
244.7-3
Other Fee Total
1.00
.00
.00
1:00
Grand Total
686.23
.00
.00
686.23
LQPERMIT
NOTE:
REMOVE EXISTING .JACARANDA
TREE AT S. PROPERTY LINE A5
PER HOA RECOMMENDATION5
FOR POOL/PATIO MA I NTENNANCE
REGARDING ME55Y TREES.
GOLF COUR5E
PROPERTY LINE
+18"
®()
LOW VOLTAGE +12" +12" +
LOUVERED LIGHTS ON
FACE OF 2 COLUMNS, T.
TYP. i 2'
GRASS AREA
(EXISTIN6)
Chi
W 1-24BOX
Z
J
MluI
Q
�-
CH
NEVI MAi5ED PLANTER AT -
+24" WITH CONCRETE GAP
AND STUCCO FACE (KEEP
NEW PLANTERS MIN. Q" OFF
EXISTIN6 WALLS AT ALL
SIDES)
NEW RAISED PLANTER AT +16"
WITH CONCRETE GAP AND
STUCCO FACE (KEEP NEW
PLANTERS MIN. 01" OFF
EXISTIN6 WALLS AT ALL
SIDES)
NE I GHBOR I NG
RESIDENCE
Uj
5'-6"
POOL
RAISED BOND BEAM AT +12" AND
COLUMNS AT +18" WITH CONCRETE
GAPS AND QUARTZITE VENEER AT
ALL SIDES
O +IS"
LT.
IG 1
IG 1
M 5'-611 Ic
O
'BUILT-IN BARBECUE TILE
If ism COUNTERTOP TO MATCH POOL
I\- -.1101111111
TILE AND STUCCO FACE TO
MATCH HOUSE
EXISTIN6 PLANTER TO
REMAIN AS IS (NO
CHANGES
NEW PAVER DECKING, SEE
ATTACHED PHOTOS FOR SAMPLE
EXISTING WALLS, TYP.
(HATCHED)
POOL EQUIPMENT LOCATION
(HEATER, FILTER, PUMP)
EXISTING
RE=51 DENGE
GUE5T
HOU5E
.8
EXISTIN6 WALLS, TYP.
(HATCHED)
NIC 4OLS RESIDENCE
52' X 15'
45-1 S.F. 98' PER
642 S.F. GONG. TO BE REMOVED AT REAR
555 S.F. GONG. TO BE REMOVED AT SIDE
15"1 S.F. CONCRETE COPING AND GAPS
117a S.F. NEW PAVERS AT REAR
555 S.F. NEW PAVERS AT REAR OF SIDE YARD
515 S.F. NEW PAVERS AT FRONT OF SIDE YARD
TYPE GUNITE 51ZE 52' X 15'
SURFACE AREA OF POOL 457 5.F.
T. LT.
TY
Z
PALMS
SIZE X 50. FT. PER.
J
24BOX
FEET KEY BOTAbUCAL NAME
COMMON NAME
# OF LIGHTS IN POOL
2
CH CHAMAEROPS HUMILIS
MEDITERRANEAN FAN PALM
EXTRA 5WITCH FOR SPA LIGHT
tuQ
O
RAISED 5PA 5PILLWAY5
�
=
HOUSE O
(L
O
COLUMNS,
SHRUBS
TYP. .le
15GAL
'BUILT-IN BARBECUE TILE
If ism COUNTERTOP TO MATCH POOL
I\- -.1101111111
TILE AND STUCCO FACE TO
MATCH HOUSE
EXISTIN6 PLANTER TO
REMAIN AS IS (NO
CHANGES
NEW PAVER DECKING, SEE
ATTACHED PHOTOS FOR SAMPLE
EXISTING WALLS, TYP.
(HATCHED)
POOL EQUIPMENT LOCATION
(HEATER, FILTER, PUMP)
EXISTING
RE=51 DENGE
GUE5T
HOU5E
.8
EXISTIN6 WALLS, TYP.
(HATCHED)
NIC 4OLS RESIDENCE
52' X 15'
45-1 S.F. 98' PER
642 S.F. GONG. TO BE REMOVED AT REAR
555 S.F. GONG. TO BE REMOVED AT SIDE
15"1 S.F. CONCRETE COPING AND GAPS
117a S.F. NEW PAVERS AT REAR
555 S.F. NEW PAVERS AT REAR OF SIDE YARD
515 S.F. NEW PAVERS AT FRONT OF SIDE YARD
50ALE 1/8'.' = P
EA
5PECIFICATI ON5
TYPE GUNITE 51ZE 52' X 15'
SURFACE AREA OF POOL 457 5.F.
TY
5PA 5PECIFICATION5
PALMS
SIZE X 50. FT. PER.
10GAL 15 AL
24BOX
FEET KEY BOTAbUCAL NAME
COMMON NAME
# OF LIGHTS IN POOL
2
CH CHAMAEROPS HUMILIS
MEDITERRANEAN FAN PALM
EXTRA 5WITCH FOR SPA LIGHT
2
TOTAL
RAISED 5PA 5PILLWAY5
MOTOR BOOSTER
SPECIAL NOTES
BLOWER CLEANER
CONSTRUCTION OFFICE PHONE #
TY
EXCAVATION
SHRUBS
iGAL 5GAL
15GAL
OTHERS KEY BOTANICAL NAME
COMMON NAME
12
COPING SPECIAL
CBB CARISSA MACROCARPA
BOXWOOD BEAUTY
PENCE TYPE
TILE TRIM MASTIC
IC IXORA COCCINEA
FLAME OF THE WOODS
CONCRETE REMOVAL LOADS
MISC.
ND NANDINA DOMES11CA
HEAVENLY BAMBOO
5
STUMP REMOVAL BY
JB BUXUS JAPONICA
JAPANESE BOXWOOD
1
BY UP TO 157 5.F. GONG.
RID ROSMARINUS OFFICINALIS
ROSEMARY
2
EXPANSION JOINTS
A ASPARAGUS SPRENGERI
MASTIC FOOTING
2
STEEL
OLE OLEA EUROP EA
LITTLE OLLIE "DWARF "
29
6" R.B.B. ft. 12" R.B.B. ft. IS" R.B.B. ft.
TOTAL
SURCHARGE DEEP END RAMP
DECCO DRAIN DIVING BOARD JIG
LOVE5EAT IN51DE ft. OUTSIDE ft.
SLIDE INETALLTION
SPA WALL WIDTH In. OTHER in,MASONK"r
CITYROUND
WALL VOINEL/MISC.
COVER
PLUMBING
SURFACE
TYPE ft. X
KEY DESCRIPTION
SPECIPWATION
HEATER SIZE
FOOTINGS R.B.B. FACING
BOOSTER PUMP 51ZE
FIREPIT TYPE SIZE
SKIMMER TYPE
EQUIP. WALL TYPE ft. X
CARETAKER # OF HEADS
FENCING t+
TY
MISG.
NaSCEUNEOUS
PEBBLE
P -TRAP BACK WASH TO
BOUMERS
VARIOUS SIZES
50ALE 1/8'.' = P
EA
5PECIFICATI ON5
TYPE GUNITE 51ZE 52' X 15'
SURFACE AREA OF POOL 457 5.F.
PERIMETER 418' DEPTHS MIN. 5.5 MAX 5'-6" _
5PA 5PECIFICATION5
ELECTRICAL
SIZE X 50. FT. PER.
BY LENGTH ft.
5PA DAM WALL WIDTH
TIME CLOCK SUB PANEL
# OF JETS
# OF LIGHTS IN POOL
LIGHT BOOSTER PUMP
OUTSIDE G.F.I. LIGHTS G.F.I. OUTLET
CA. AQUA AIR -BAR t BLOWER
EXTRA 5WITCH FOR SPA LIGHT
BLOWER ONLY
BLANK PLUGS
RAISED 5PA 5PILLWAY5
MOTOR BOOSTER
SPECIAL NOTES
BLOWER CLEANER
CONSTRUCTION OFFICE PHONE #
MISC.
EXCAVATION
TYPE
ACCESS FROM
COPING 4 TILE
ELEVATION
COPING WHITE
DEEP END RAMP
COPING SPECIAL
FENCE REMOVED BY
TILE TYPE
PENCE TYPE
TILE TRIM MASTIC
TRASH REMOVAL LOADS
6" R.B.B. ft. 12" R.B.S. ft. IS" R.B.S. ft.
CONCRETE REMOVAL LOADS
MISC.
TREE REMOVAL BY
STUMP REMOVAL BY
DECKING 202-1 5.F. PAVERS
DIRT PAD
6" R.B.B. ft. 12" R.B.B. ft. 18" R.B.B. ft•
BY UP TO 157 5.F. GONG.
WALKOUT/MISC.
FINISH COLOR
ROCK PACK
EXPANSION JOINTS
MASTIC FOOTING
STEEL
STEPS TYPE
EXPANSIVE 501L
CANTILEVER
6" R.B.B. ft. 12" R.B.B. ft. IS" R.B.B. ft.
DECK DRAINS CURB CORE
SURCHARGE DEEP END RAMP
DECCO DRAIN DIVING BOARD JIG
LOVE5EAT IN51DE ft. OUTSIDE ft.
SLIDE INETALLTION
SPA WALL WIDTH In. OTHER in,MASONK"r
WALL VOINEL/MISC.
COPING TYPE
PLANTER WALL
PLUMBING
FILTER SIZE
TYPE ft. X
POOL PUMP 5!ZE
CAP BACK UP WALL ft
HEATER SIZE
FOOTINGS R.B.B. FACING
BOOSTER PUMP 51ZE
FIREPIT TYPE SIZE
SKIMMER TYPE
EQUIP. WALL TYPE ft. X
CARETAKER # OF HEADS
FENCING t+
OTHER CLEANER STUB ONLY
MISG.
FILL LINE SLIDE LINE
PEBBLE
P -TRAP BACK WASH TO
GAS LINE STUBS
LIGHTS POOL 5PA
FOUNTAIN5/5PRAYHEADS
ROPE RIN65 EYEBALLS REQUIRED
LIGHTS IN POOL IN SPA
COLOR NAME TILE
STUB SET EQUIPMENT
SPECIAL EQUIPMENT
5AWCUT AUGER
DIVING BOARD SIZE
MISC.
MODEL COLOR
SLIDE SIZE
GUNI TE
MODEL COLOR
5UNITE INSPECTION REQUIRED YES NO
POOL COVER SOLAR HEATING YES NO
ROPE RIN65 GRAB RAILS
FENCING
DEEP END RAMP
TO MEET ALL LOCAL CODE REQUIREMENTS BY BUYER PRIOR TO
6" R.B.B. ft. 12" R.BE. ft. 18" R.B.B.
PREPLASTER INSPECTION
®TREK
LOVE5EAT EXTENDED 2nd STEP
NOTCHED BOND BEAM
COPING CANTILEVER ft.
5AP DAM WALL WIDTH
OWNER RESPON5IBILITIE5
OWNER TO: (1) TAKE NOTICE THAT POOL AND EQUIPMENT LOCATION 15 SUBJECT TO ACCEPTANCE OF LOCAL BUILDING DEPARTMENT AT TIME
OF 155UANCE OF PERMIT
(2) TAKE NOTICE THAT PLATINUM POOLS 15 NOT RESPONSIBLE FOR: UNDERGROUND CONDITIONS OR JBJECTS, AND ANY DAMAGE
TO CURBS, SIDEWALKS, DRIVEWAYS, LAWN5, OR OTHER ITEMS IN THE ACCESS AREA
(3) SEE THAT ALL FENCING, GATE5, AND GARAGE DOORS MEET LOCAL CODES FOR A POOL ENCLOSURE PRIOR TO PREPLA5TER INSPECTION
(4) FILL POOL IMMEDIATELY AFTER PLASTER. (FOLLOW INSTRUCTIONS,DO NOT USE RUBBER HOSE)
(5) TAKE NOTICE THAT THIS DRAWING 15 THE SOLE PROPERTY OF PLATINUM POOLS AND THAT ANY USE WITHOUT WRITTEN PERMISSION
OF PLATINUM POOLS 15, PROHIBITED BY LAW.
OWNER APPROVES PLAN, POOL, AND EQUIPMENT LOCATIONS AND HAS READ THE RE5PON51BILITIE5 AND NOTICES ABOVE.
516NATURE(5) DATE
51GNATURE(5) DATE
REVISIONS
Delta Dau By DeKrip -of Change
MATERIAL SELECTIONS
MATERIAL CHOICE
0
0 _
0- -
0 —
STREET
57-061 MERI ON
CITY LAS GNU I NTA CA.
JOB ADDRESS
PHONE #'S
OFFICE
DIG ALERT #
LOT #
TRACT #
PAGE BOOK
GATE CODE:
MAIL ADDRESS
P Ili"
laitinum. P0, o I s
i Bermuda Dunes,
SVIDMING POOL PLAN FOR
NAME(5)
STREET
57-061 MERI ON
CITY LAS GNU I NTA CA.
JOB ADDRESS
PHONE #'S
OFFICE
DIG ALERT #
LOT #
TRACT #
PAGE BOOK
GATE CODE:
MAIL ADDRESS
CITY
CONSTRUCTION OFFICE PHONE #
SCALE:
1/8"=19-0"
DATE:
8-20-12
DRAWN BY:
JOHN
SOLD BY:
BRENT
SHEET #
P Ili"
laitinum. P0, o I s
i Bermuda Dunes,
Bin.#
Crit' 0f Lel Quo:
lhta
Building & Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 - (760) 777-7012
Bu11ding Permit Application and Tracking Sheet
Pemilt #
'Z
Project Address: �
Owner's Name:.
A P. Number.
Address: S'7�f'o� /�E%/lo
Legal Description:
Contractor. [,�j�,U(yL� (, £ JX -'141'
City, ST, Zip: ��'�/ 64— q240
Telephone:
Address: 78.E/a ST
Project Description:
City, ST, Zip:
Telephone: 746-3/,(S— 830 '
State Lic. # : 7it3 City Lic. #;
A��
Arch , Engr., Designer
lG
Address:
City., ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person: � E./U,TLp��
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq, FG: # Stories: #Units:
Telephone # of Contact Person:
Estimated Value of Project 3t
APPLICANT: DO NOT WRITE BELOW THIS UNE
N
Submittal
Req'd
'Rec'd
TRACKIING
PERMIT FEES
Plan Sets
-les.
401Plan
Cheek submitted
Item Amount ,
Structural Ca
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Calcs.
Called Contact Person
Plan Check Balance,
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted..
Mechanical
Grading plan
2'! Review, ready for correctionvissue
Electrical
Subcoutactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
E4 HOUSE:-
''' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.t.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Buildin
Arlrlrocgc V-061 riQn
Sunni se Company
aF�Q�a
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA -92253
Address 42-600 Cook; Street Suite 200
City Zip Tel.
Paha Desert 92260 1 668-2828
Contractiliational Mortgage A rand
Address
Same
State Lic. I City
& Classif. 288130 Lic. # 398
Arch., Engr.,
Designer
Address Tel.
City (Zip ( State
Lic. #
. . LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)
t. of Division 3 of the Business and Professions Code, and my license is in full force and
effec
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,Bushmess and Professions Code: Any city or county which requires a
Permit to construct, alter, improve, demorsh, or repair any structure, prior to its issuance also
requires the applicant for such permit to We 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 five 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 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 win 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,
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.)
O 1 am exempt under Sec. a_ & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
O Copy is filed with the city. . ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N Me permit is for one hundred dollars (E100) 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. ff. after making this Certificate of Exemption you should became
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this pemM 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 property filled out, signed and validated, and is subject to
expiration if 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
No. 07247
. . 5--4
BUILDING: TYPE CONST. OCC: GRP.•
A.P. Number PGA
,Legal Description Tract 24801
Project DePs� a z SH - Pan H30
Sq. Ft.
Size
No.
Stories
No. Dw.
Units
New ❑ Add ❑
Alter ❑
Repair ❑ Demolition ❑
Estimated Valuation
$234,923
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
56st.
Con
Const.
la t
Mech.
73,00
Electrical
L • 11
Plumbing
hili*
S.M.I.
Grading
Driveway Enc.
Infrastructure��
/_
e Credit
♦ . 00
infra Due.
c:
TOTAL
REMARKS,
1 .s
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 Z%28/90 Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
ROUGH PLUMB. BONDING
2ND FL. SQ. FT.
STORAGE TANK
YARD SPKLR SYSTEM
WER ORSEP elfROUGH WIRING
MOBILEHOME SVC.
BAR SINK
POR. Sp, FT. ®
(ROUGH) _ METER LOOP
HEATING (FINAL)
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
CAR P. SO. Fr. ®
FINAL INSP.
WALL SQ. FT.
WATER SYSTEM
DRINKING FOUNTAIN.
SQ FT ®
LUMBER GR.
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
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.
SQ. FT. ® c
BATH TUB
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/a c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
FINAL INSPECTION
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
ROUND PLUMBIC UNDERGROUND
A.C. UNIT
COLL. AREA
r SLAB GRADE C -
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER ORSEP elfROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.V.OAS
(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.
FINAL INSP./6�17 Q
✓
FRAMING
FINAL INSP.
_
ROOFING 6-16
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
GLATHING vV
MESH
INSULATIONISOUND7—(✓ —�(/
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL