9489 (RPL)Buildin
Address 73-220 Cadiz
Owner
Geor4e Jeffery
/ 4 uG�a
. .
P.O. BOX 1504 N o .
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
BUILDING: TYPE CONST. OCC: GRP.:
Address same
City Zip Tel.
La Quints 92253
Contractor
Rick Cochran°s Pool Const.
Address
4511 E. Sunny Dunes #A
City Zip Tel.:
P.S 92264 3.20-2030
State Lic. City
#
& Classif. 312674 i
Arch., Engr.,
Designer
Address Tel.
F
City Zip State,
Lip. # ,
LICENSED CONTRACTOiN,'S DECLARATION
hereby affirm that I ar Ilcensed under p(ov sii ons of Chapter 9 (commencing with Section
of Division 3•df the'Busings and'P.rofes�' TCode, and m lice
nse�'�in full force and
',UNATUH F..' / - e — U-1✓ 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 statemeni'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 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 improve for the purpose of sale.)
O 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.)'
❑ 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
O Copy is filed with the city. O Certified copy is hereby furnished.
r
CERTIFICATE OF EXEMPTION FROM'
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.) 1 '
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: If, 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
1 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 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
P. Number
Description
Project Description POOL AND SPA
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ After ❑ Repair ❑ Demolition ❑
Estimated Valuation 17, 000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. .
117.00
Const.
180.00
Mech.
24. 00
Electrical
45.00
Plumbing
27.00
S.M.I.
1.70
Grading
Driveway Enc.
Infrastructure
T
i
TOTAL
�� U
REMARKS
nr,r_ n • x R_ r-r•:I ONA._,IeN _04 s �
.TP
TMAL I _ v
Te P <70
irk ;'rNr "r�
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:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
2ND FL. SO. FT. ® '
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS ,
CAR P. SQ. FT.
DUCT WORK
DRAINAGE PIPING
WALL SO. FT•
DRINKING FOUNTAIN.
SQ FT ®
HEATING (FINAL)
URINAL
ESTIMATED CONSTRUCTION VALUATION $
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
GRADING
CU. yd.
$ plus x$
LAUNDRY TRAY
AIR HANDLING UNIT CFM
FRAMING
KITCHEN SINK j
ABSORPTION SYSTEM 133M.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER t
BOILER. B.T.U.
SO. 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
GAR. FIREWALL
GAS PIPING
PERMIT FEE
PERMIT FEE I.
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE XLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
'GROUND PLUMBING l ` UNDERGROUND
! L L C
A.C..UNIT
COLL. AREA
SLAB GRADE t
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 APPJEQUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP. VV�
�� It U.
GRADING
CU. yd.
$ plus x$
'
_$
LUMBER GR.
FRAMING
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 SIGNATUREWINITIALS
GARDEN WALL FINAL
,
PROPOSED CONSTRUCTION ASSEMBLY
AVERAGE U -VALUE (Computer Simulation]
project title climate zone
project location
documentation author date
RESIDENTIAL
Form-ZC-
' IRov.9/fl�j
Enforcement Agency Use Only
building permit number
checked by
date
List of Construction Coinponerits R -Value
(for section between framing members) of Components
I
2. , �/2� Com. 6 �•
J
3.'-
4:
F
Sketch of Construction' Assembly
6.
Framing Size"" x 7•
Framing Spacing-' o.k:. 8. Inside Surface Air Film O.
(Use Table 2, Performance Values)
9. Outside Surface Air Film d•
(Use Table 2, Performance Values)
Check one:
Total Thermal Resistance (R T)
® Floor sum of the above
❑ Wall
), Ceiling/Roof AVERAGE U VALUE OF ASSEMBLY'.
If Wail, check the
appropriate weight:..
Btu/(hr.ft2 W OF)
❑ less than 25 Ib/ft= .
Framing - R T from
E3 25 to 40 Ib/ft= - Factor above
Use $iis l�Valt� for Code car�lison _
® greater than 40 Ib/ft= _
14-79740 _ - -
HEAT TRANSFER COEFFICIENT
PROPOSED CONSTRUCTION ASSEMBLY
Form 3R
. (8/81)
Enforcement Agency Use Only
owner project title bulloing permit number
project location checked by
i'
documentation author Cate
Sketch pf Construction Assembly List of Construction Components R
Q
ffor section between framing members) (from Table 3 11
rip—
r
2.
3.
4.
5.
Framing Size " z 6.
Framin§ Soacing O.C.
7.
Check one:
--�O�
• `/ 8. Inside Surface Air Film (from Table 3.18) ............ .
7� Ceiling/Roof
Floor 9. Outside Surface Air Film (from Table 3-1Bl............
• Wall -
_ Total Thermal Resistance (RT) �
If Wall, check the -
sum of the above
appropriate weight:
less than 25 Ib/h2
25 to 40 Ib/ft2 AVERAGE U VALUE OF ASSEMBLY
greater than 40 Ib/fit
Btu/(hr .h2 •CFI
Framing RT from above
Factor from
Table 3.6
Use this U value for heat toad
calculation or Code Comparison