10489 (RPL)P.O. BOX 1504
Building 79-185 JACK RABBIT' LA QUINOTAC
AddressCAL CALIFORNIA 92253
No. 10499
K 6 ® CONSTRUCTION
BUILDING: TYPE CONST.
OCC: GRP.
Mailing
Address P 0 BOX 5181-315
A.P. Number
CityZip
Tel.
LA QUIYTA
92253
360-9944
Legal Description
Project Description
POOLS AND SPAS
'ontractor
CONTEMPO POOLS AND SPAS
Address
41-65G BROWNSTOWN DR
City
Zip
Tel.:
BER14UDA DUN'S
360-0944
Mate Lic.
City
i Classif.
Lic. #
Sq. Ft.
No. No. Dw.
Size
Stories Units
4rch., Engr.,
)esigner
New ❑ Add ❑
Alter ❑. Repair ❑ Demolition ❑
Address
Tel.
'ity
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 license is in full force and
effect.4si.)�i�Sirifl'9i%C'.^a�
SIGNATURE .y DATE
' OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
'eason: (Sec. '7031.5,Business and Professions Code: Any city or county which requires a
)ermft to construct, alter, improve, demolish, or repair any structure, prior to Its issuance also
'equines the applicant for such permit to file a signed statement that he is licensed pursuant to..
he provisions of the Contractor's License Law, Chapter. 9 (commencing with Section 7000) of
Xvision 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
'or 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.($500).
-1 I, as owner of the property, or my employees with wages as their sole compensation, will
Jo the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's license Law does not apply to, an owner of property who
Sutjds or improves thereon and who does such work himself or through his own employees,
'rovided that' such improvements are not intended or offered for sale. If, however; the .building
x improvement is sold within one year of completion, -the owner -builder will. have the burden
)f proving that he did not build or Improve for the -purpose of safe.)
b l; as' owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: -The Contractor's License Law
does not apply to an owner of property- who, builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ,
� I am exempt under Sec. B. & P.C. for this reason
Estimated Valuation
15 000
PERMIT
- AMOUNT
Plan Chk. 'Dep.
Plafl Chk. Bal.
CC
Y • �'�%
Const..
1 b • f$fJ
Mech.
24 � 00
Electrical
45.00
Plumbing
27 • 00
S•MP
1 • 50
Grading
Driveway Enc.
)ate owner
Infrastructure
t
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 cer tified. copy thereof. (Sec. 3800, Labor Code.)
Policy`No. Company
Copy. is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
,� •
CERTIFICATE OF EXEMPTIONFROM
WORKERS' COMPENSATION INSURANCE
REMARKS
R AK S f :r 4A A 7 i P 64-.4f)-01) ,
(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 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.
ICY LR,\:J1 I fUlt4L I �#�^i,liti
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.
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance -of the
Nork for which this permit is issued. (Sec. 3097, Civil Code.)
Side Street Setback from Center Line
Side Setback from Property Line
Lender's Name
FINAL DATE
INSPECTOR
Lender's Address
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.
Issued by:
Validated by:
Date Permit
Signature of applicant Date
Mailing Address
Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ., FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
I ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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 ® 1% c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3Vic
HOUSE SEWER
REMARKS:
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
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
GRADING
-cu. yd.
$ -Plus-X$-=$
LUMBER GR.
INAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE'ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION -
CERT. OCC. '
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL