15290 (RPL)rf
P.O. BOX 1504 No. 5290
78-495 CALLE TAMPICO
Addtless x;44°-480 Camino Lavanda LA QUINTA, CALIFORNIA 92253
Owner -..Century/Brown
MailingBUILDING: TYPE CONST. OCC. GRP.
Address - 1535, outi3 >°cD" St •
- i` A.P. Number..{
City Zip Tel.
San Bsraardia s CA 92409 Legal Description
ContractorPoul and Spa
Dodson Pools � Project Description
Address -
68- C05 A Prez Rd. Ell'
c8atliedral Cit; Zgp CA92234 Tel
324- 1232
State Lic. -City
& Classif.•.'.,574127 1.
Lic. # 1044
Sq. Ft.
No. No. Dw.
Size
Stories Units
Arch., Engr-, �'
-Designer ��
New ❑ Add ❑
Alter ❑ Repair ❑ Demolition ❑
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°hcerise is;in full force and
• effect. '4
SIGNATURE - DATE
i OWNEWBUILDER DECLARATION
Estimated Valuation
$115 000 0()
I herebyaffirin that I am exempt from the Contractor's License Law for the following•
reason: (Sec. 7031.5,8usiness 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 file a signed statement that he is licensed pursuant to
PERMIT
•� - AMOUNT
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 Any Section 7031.5 by 'any for
Plan Chk. Dep.
alleged exemption. violation of applicant a permit
subjects the applicant to a civilpenally of not more than rive hundred dollars ($500). .
Plan Chk. Bal:
111.0
O 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, Buisness and
Const.
171.00
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or Inproves'thereon and who does such work himself or through his own employees,
Mech.
24.00
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
Electrical
45.00
- of proving that he did not build or improve for the purpose of sale.)
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
Plumbing
27. 00
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
S.M.I.
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
•
Grading
❑ I am exempt under Sec B. & P.C. for this reason
Driveway Enc.
a 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. I Company
. O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
378.15
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed ff the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thF 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: ft, 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND
SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION' TO THE COST OF COMPENSATION,
DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
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
REMARKS
ZONE: BY:
Minimum Setback Distances:',
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback7from Center Line
Side Setback from Propecty;L'ine
FINAL DATE!u INSPECTORA i�
Issued by: Date .. �-J � Permi
t✓
Validated by:�
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBIWj FEES
1ST FL. $0. FT. ® $
UNITS
SETBACK
2ND FL. SO. FT. p
UNDERGROUND
YARD SPKLR SYSTEM
POR $0 FT ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. S0. FT. ®
SEWER OR SEPT
DRAINAGE PIPING
WALL $0 FT ®
ROCK STORAGE
DRINKING FOUNTAIN
SO. FT. ®
METER LOOP
URINAL
ESTIMATED CONSTRUCTION VALUATION $
REINF. STEEL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER HEATER
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LUMBER GR.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FRAMING
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
FIRE ZONE ROOFING
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ac
HOUSE SEWER
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 A ELECTRICAL HEATING a AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING `
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPT
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
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
7
U
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESlINITIALS
GARDEN WALL FINAL
0
o
LITE WATTS
! SHAPE PLKIMETER
TRI LEVEL SEATS
f -ILE SIZE
—
22" 24" 27"
I ILE COLOR_—
DAMWALL WIDTH
RAISE BEAM
I
SPILLWAY SIZE X
11I i COPING
t
,POOL CAPACITY
GALS
OPEN _. CLOSED -
PUMP-CAPAC.TY
?v !
i JETS.#—__-------
; MOTOR HP
I -P_
FILTER
SQ CT
FILTER RATE
GPM
P/LTURNOVER
rayheads
spa raised +6"
(_ HKS
s RETURN LINES. 11 I
- P i . 1
•
_...- 1
MAIN DRAIN —
ro AN,
a 4'
r
twI deck
W door' 1W ME planter `
W S W
& spa
switches
` W •-
SKIMMER_MODEL 1
CHECK VALVE
HEATER LAARS SIZE BTU
GASLINE BY
_POOL LIGHT
SPA LIGHT _
CLOCK
ELECTRIC BY --_—
ELECTRICAL _BONDING BY
_TILE AND COPING
DECKING BY _
iecco drain � J�.-�,—�� ... i��o'
CONTRACTOR cannot assume
responsibility for damage to
curbs, sidewalks, driveways,
i cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprink]ers, telephone lines
or shrubs. When access is made
through a neighbor's property it is
! understood that you, the owner,
! have that neighbor's permission
and assume full responsibility.
ti
door r
4 Name.: Srowil,—i 1 w1tJ
` I
I address: '-'41-1 -14250 Conn n o
L C� v Cv-i C, CL
� Crty: L a � u. ,, i c`
i
=` Doafso�
' Pogo%
i
SNOW ROOM
68-805-A PEREZ RD. STE. E-9
CA—yECRAL CITY CA. 922�4
J