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14036 (RPL)I' t. w;, r P.O. BOX 1504 Buildin78-105Addrress 78-750 Irwin LA QUINTACCALIFORNIA 92253 Owner Prank Zsdextek Mailing Address same Citya Zip Tel. Qui nta.. O 92253 Contractor r & F Pools 1 AddApSsu. StBX 11206 Cit�aim sere# z� 9225. Tel 345-5070 State Lic. ' City & Classif. , C•-53 476807 Lic. # 130 -Arch.-.Engr.; - — - — - Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION RI hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 ofthe_Business and Professions Code, and my license is in full force and d effect. '. SIGNATURE -" DATE OWNER -BUILDER DECLARATION I hereby.affirm that I am exempt from the Contractors License Law for the following .reason:;:(Sec::, 703 1.5, Business and Professions Code: Any city or county which requires a ,:.,permR+to`.constrbct, alter, 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 the provisions i of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of theBusinessand 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 five hundred dollars (8500). O 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.) ❑ 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 aVirm 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.) Pol��N.t-. company `-x y i-^ M e» 4s' , ,r 4r Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars (8100) valuation or less.) ' I certify that in the performance of thg 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 Ihereby 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 No. 14036 ;. BUILDING: TYPE CONST. • OCC: GRP.- A.P. Number Legal Description Project Description P*oZ and Spa 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: Sq. Ft. Size No. Stories No. Dw. Units New ❑ Add ❑ _ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $13r500.00 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 99.45 Const. .153.00 Mech. 24.00 Electrical 45.00 Plumbing 27.00 S.M.I. Grading Driveway Enc. Infrastructure y TOTAL 348.45 REMARKS A c A 1) 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. SQ. FT. ® $ UNITS A.C. UNIT 2ND FL. SQ. FT. SLAB GRADE YARD SPKLR SYSTEM POR. SD. FT. ® MOBILEHOME SVC. BAR SINK GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS CAR P. SQ. FT. SEWER OR SEPTIC TA DRAINAGE PIPING WALL SQ. FT. DUCT WORK DRINKING FOUNTAIN SQ. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ METER LOOP WATER PIPING NOTE: Not to be used as property tax valuation REINF. STEEL FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER WATER HEATER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRYTRAY AIR HANDLING UNIT CFM 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 (+� \\ l t SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 1+/e c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FIRE ZONE ROOFING 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. At, 1 ` BONDING V HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TA 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 (+� \\ l t 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 DESIGNED FOR MR/MRS CITY,., BUILDING & ACCEPTE �L�B•�ECT' AND At GATE 01-IMEA TO BE ENCLOSED BY q,L1YU IVI FT r A 0 Ul N; i A TETY DLEPA 'I M ENT IDITIONALLY -OR CONSTRUCTION INSTALLATION AS PER PPLICABLE SECTION THROUGH POOL Surface�� d Spa Size S Total Perimeter ' EXCAVATION Concrete Removal sq ft Trash Loads Stump Removal STEEL Deck Ties Yes No PLUMBING Gas Line Number of Returns Number of Jets Anti -Syphon Valve__f Fill Line Footage ft Stub fo Auto Cleaner Yes No Type Other GUNITE Seats or Ledges Deep End Walk Out Yes No Raised Bond Beam sq ft TILE Type Brick Work Oth er DECKS - Fin.ish ,keo �- 1` Total sq ft.— Drains tDrains Mastic Steps POOL EQUIP Filter C 1= L--> :14- Pump .�c L'A_�_ Auto Cleaner — Heater /4ka- Jet Pump Maintenance Kit Diving Board Slide Additional Itemes 1/8" = 1 Foot i '. spy' •:;�' �•.• :r'_;,.:� : •(,:. :;:.`til;.-..• DESIGNED FOR MR/MRS CITY,., BUILDING & ACCEPTE �L�B•�ECT' AND At GATE 01-IMEA TO BE ENCLOSED BY q,L1YU IVI FT r A 0 Ul N; i A TETY DLEPA 'I M ENT IDITIONALLY -OR CONSTRUCTION INSTALLATION AS PER PPLICABLE SECTION THROUGH POOL Surface�� d Spa Size S Total Perimeter ' EXCAVATION Concrete Removal sq ft Trash Loads Stump Removal STEEL Deck Ties Yes No PLUMBING Gas Line Number of Returns Number of Jets Anti -Syphon Valve__f Fill Line Footage ft Stub fo Auto Cleaner Yes No Type Other GUNITE Seats or Ledges Deep End Walk Out Yes No Raised Bond Beam sq ft TILE Type Brick Work Oth er DECKS - Fin.ish ,keo �- 1` Total sq ft.— Drains tDrains Mastic Steps POOL EQUIP Filter C 1= L--> :14- Pump .�c L'A_�_ Auto Cleaner — Heater /4ka- Jet Pump Maintenance Kit Diving Board Slide Additional Itemes 1/8" = 1 Foot i DESIGNED FOR MR/MRS CITY,., BUILDING & ACCEPTE �L�B•�ECT' AND At GATE 01-IMEA TO BE ENCLOSED BY q,L1YU IVI FT r A 0 Ul N; i A TETY DLEPA 'I M ENT IDITIONALLY -OR CONSTRUCTION INSTALLATION AS PER PPLICABLE SECTION THROUGH POOL Surface�� d Spa Size S Total Perimeter ' EXCAVATION Concrete Removal sq ft Trash Loads Stump Removal STEEL Deck Ties Yes No PLUMBING Gas Line Number of Returns Number of Jets Anti -Syphon Valve__f Fill Line Footage ft Stub fo Auto Cleaner Yes No Type Other GUNITE Seats or Ledges Deep End Walk Out Yes No Raised Bond Beam sq ft TILE Type Brick Work Oth er DECKS - Fin.ish ,keo �- 1` Total sq ft.— Drains tDrains Mastic Steps POOL EQUIP Filter C 1= L--> :14- Pump .�c L'A_�_ Auto Cleaner — Heater /4ka- Jet Pump Maintenance Kit Diving Board Slide Additional Itemes 1/8" = 1 Foot