14620 (RPL)♦ lyt
44.
P.O. BOX 1504 N o . 14 6 2
Addrress 79-655 $tax Flower `i • LA QU NTA, CAL FORNIIA 92253 '
Owner
Betty KasAar ff
'Mailing BUILDING: TYPE CONST.. OCC: GRP.
' '
r Address Same
A.P. Number
CityZip Tel.
L8 •Quinca i CA 92253 Legal Description
Contractor Rbo-A and . Spa
1A lItt�3ll Pool Conbtk zction Project Description
Address
78-931 Ave. 41.
City,Zip Tel.:
Be_n~ da .DUnes 8A 92201 3630-x4242
State Lic. City
& Classif. ,, C-5.3 665655 Lic. # 2€154 Sq. Ft. No. No. Dw.
Arch:, -Engr:,
Size -•• Stories. Units
DesignerNew ❑ Add ❑ Alter ❑ Repair El 'Demolition ❑
Address Tel.
City Zip State
Lic. # �.
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that 1 am licensed under provisions of Chapter 9 (commencing with Section - r
7000) of Division 3 of the Business and Professions. Code,. and my license is in full force and .
- effect.
SIGNATURE - - DATE
OWNER -BUILDER DECLARATION
Estimated V81UdtlOrl, ,
I hereby affirm that I am exempt from the Contractors License.Law for the following7.. ' ,. '
reason: (Sec. 7031.5,Business-and Professions, Code: Any,,city.or. county which requires a •.300.00
permit to construct, alter, improve, demolish, or repair any structure, pdor.to* its issuance also -) -
requires the applicant for such permit to tile's signed statement that he is -licensed- pursuant to .,.. PERMIT - AMOUNT
the provisions of the Contractor's License taw, Chapter 9 (commencing with -Section 7000) of
Division 3 of the Business and Professloris- Code, or that. he Is exempt therefrorim, and the basis - -
Plan Chk. Dt?p.
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). ` ° . c e
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk. Bal. 64.35
do the work, and the structure is not intended or offered for sale. (Sec.^7044, Suisness and Const. ' `QQ
Professions Code: The Contractor's. License Law does not apply to an. owner of property who - , •
builds or Improves thereon arid' who does such work himself or through his own employees,. MachjQ
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 `
of proving that he did not build or improve for the purpose of sale.) - 45.00 `
O I, as
7 2
owner of the property, am exclusively contracting with licensed contractors -to con- Plumbing QQ
struct the project. (Sec. 7044, Business and .Professions Code: The Contractor's License Law y
• • does not apply to an owner or property -who builds �or improves thereon, and who contracts .for S.M.I. n -
such projects with a contractors) licensed pursuant to the Contractor's License Law.) _
' ❑ I am exempt under Sec. B. 8 P.C. for this reason Grading
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. O Certified copy is hereby furnished.
. 1., . ' TOTAL 259.35
CERTIFICATE OF EXEMPTION FROM. - -REMARKS
.
WORKERS' COMPENSATION INSURANCE
(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 thg work for which this permit is'issued, I shall not
employ'Any pparson 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
u-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 37D6 OF THE- LABOR- CODE, INTEREST, AND
ATTORNEY'S FEES. ,
This is'a'bu lding perni)t when properly filled,out, signed and validated; and is subject to
expiration if work thereunder is suspended for 180 days:
I certify that 1 have read this applioation.and state that the above information is correct:
1 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. Line
Side Street Setback from Center.L'ine'
Side Setback from Property Line .
FINAL DATE n INSPECTOR
Issued by; Date �Ppy
Validated by:
. Iu
Validation: I A til 2 12CIE
v
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBINU FEES
IST FL. SO. FT. ® $
UNITS
?
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
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
METER LOOP
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SO. FT. ®
GAS (FINAL)
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
GRADING
cu. yd.
$ Plus -X$-=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
UUU
LAUNDRYTRAY
AIR HANDLING UNIT CFM
REMARKS:
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
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 ® t+/a c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/4c
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
t J
SETBACK
GROUND PLUMBING
I UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING 4,1
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
/
GAS (ROUGH) / V
CCC
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
UUU
� � /��
7
C/
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
.7d
X
0.)Y/ Bbl
m/v i
17
3
POOL AREA TO BEENCLOSE® BY
fltiiNiNi
uIv, 5 FT. HIGH FENCE.
To B E S ELF_CLOS ING
I N
ALL GATES TO BE SELF-CLOSING
LAND SELF -LATCHING.
CITY OF k. LA
v N TA
'F� _
BUILDING & IT
-SAFETY DEPA, TiMi i N T
t,40 i T'l
a L; AT
DATE
oe_�7 , Kas r C'ro
1-0-t "'ta
- . Ca..c-+.Js 4A
FIAMMELL Pool CONSTRUCTION
78931 41st AVENUE
BERMUDA DUNES, CA 92201
(619) 360 - 4242
LIC. & BONDED# 665655
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