14422 (RPL)P.O. BOX 1504 No. 14422
Building 78-920 Citrus LA pU NTA, CALIFORNIA92253
Address '
Owner Mr. & Mrs. Rinker `
Mailing SameBUILDING: TYPE CONST. • OCC: GRP.
Address
A.P. Number
City Zip Tel.
Iia . Qi3inta a CAI 92253 Legal Description
ContractorPooland Spa
clfiCyrc:. Pools & Spas Project Description
P
A:e3s. BOX 17.51'
:.. Cita Quinta, a CAI Zlp 92253 Tej.42--3521
State Lic.s City
& Classif. C-5'3 6514611 Lic. # 19 5 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirmythat,l am licensed under provisions of Chapter 9 (commencing with Section - -
7000) of Drvi, 6 -3'of thhe.Busi/ness and`]p�_SJfflss 9As Code, and my license is in full force and
• effect. F �/ .` f / ✓ 4U t �__ 1
SIGNATURE DATE
OWNEWBUILDER DECLARATION Estimated Valuation $15,0.00.00 '
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 alsoI
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 alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. 105.30
1 AA f1
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal. 1 V 5 . 3 n
❑ 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. 162.00
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, Mech. ' -24-00
provided that such improvements are not intended or offered for.sale. If, however, the building w
' or improvement is sold within one year of completion, the, owner -builder will have the. burden Electrical y 5 . V
rt/�/� V
I of proving that he did not b0d or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
27.00
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 S•M.I.
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
Grading
O 1 am exempt under Sec B. & P.C. for this reason
Driveway Enc.
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 Company
❑ Copy Is filed with the city...❑ Certified copy is hereby furnished.
TOTAL
363.60
i CERTIFICATE OF EXEMPTION FROM REMARKS
I WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
of less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any parson in any manner so as to become subject to the:Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: B, after making this Certificate or 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 andvalidated, and is subject to
expiration if work thereunder is suspended for 100 days:
I certify that 1 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
ZONE: BY:
Minimum'Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. 4
Side Street Setback fromailin e
Side Setback from Prop
FINAL DATE INSPECTgjR
-Issued by: Date
Validated by:
,1 c
Validation: .
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING; FEES
1ST FL. SO. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL. SO. FT. @
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SO. FT. ®
DUCT WORK
ROCKSTORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. I SO. FT.
GAS (FINAL)
TEMP. POLE
WALL SO. FT.
DRINKING FOUNTAIN
SO. FT. ®
WATER HEATER
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
ADING
cu. yd.
$ plus x$
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
REMARKS:
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 Va c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
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 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
ROCKSTORAGE
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
ADING
cu. yd.
$ plus x$
_$
LUMBER GR.
/�
FINAL INSP! 7 -`/
FRAMING
FINAL INSP.
ROOFING
�VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
AFINAL INSPECTION -/112j
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL