04-8040 (RPL)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760),777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . .
Property Address . . . . . .
APN:
Application description . . .
Property Zoning . . . . . . .
Application valuation . . . .
04-00008040
6 0 7 2 7�WH`I-TE`SAGE
764-270-999-65
POOL - RESIDENTI
LOW DENSITY RESI
6000
4
Owner Contractor
.---------------------------------------------•--------------------- 1
MERV BRANDT Owner
60727 WHITE SAGE DR
LA QUINTA, CA 92253
----------------------------------------------------------------------------
P.O. 130x 1504 a '���
78-495 CALLS TAMPICO VOICE (760) 777.70132_
LA QUINTA, CALIFORNIA 922534V FAX (760) 777-7 11
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-71
Application Number: 05i✓- 9040 I
Applicant: Date: f
vc-, 14 rz
Applicant's Mailing Address:
Architect or Engineer.
Architect or Engineer's Address:
Lic. No..
IDuu_uIIYv r=KMI I utcLAKATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any stricture, prior to its issuance, also requires the applicant for the permit to fife a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she 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 ($500).):
jg 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,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -build II have the burden of proving that tie or she did not build or improve for the purpose of sale.).
U 1, as owner of the property, am exclusively contracting with 'censed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owneris
P pert who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt undVr Sec. , B.8 P.C. fort re son _
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
—I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is
issued. My workers' compensation insurance ythis
d policy number are:
Cartier Policy Num r
I I certify that, in the performance of the work for iermit is issued, I shall not employ any person in any manner so as to become subject to the workers'compensation laws of California, and agree t, uld becomesubject the workers' compensation provisions of Section 3700 of the Labor Code, l shall
forthwith comply with those provisions.
WARNING: ffAILUAE 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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
D su
1. Eachnt
person upon whose behalf this application is made, each arson at whose request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Ouinta,
officers, agents and employees for any act or omission related to the being performed under or following issuance of this permit. its
2. Any permit issued as a result of this application becomes null and i if rk is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information ani
rrect I agree to comply with all city and county ordinances and state laws relating to bullding
construction. andhe eby authorize representatives of this county to enteron a ve-mentioned Qroperty�nspection purposes.
----------------------------------------------------------------------------
Application Number . . . . . 04-00008040
----------------------------------------------------------------------------
F PermitMECH POOL
Additional desc . .
Permit Fee . . . . 24.00 Plan Check Fee 3.75
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 9.0000 EA MECH FURNACE <=100K 9.00
----------------------------------------------------------------------------
Permit BLDG POOL PERMIT
Additional desc . .
Permit Fee . . . . 81.00
Issue Date
Plan Check Fee . . 52.65
Valuation . . . . 6000
Qty Unit Charge Per Extension
BASE FEE 45.00
4.00 9.0000 THOU BLDG 2,001-25,000 36.00
----------------------------------------------------------------------------
Permit
Additional desc
Permit Fee . . . .
Issue Date . . . .
ELEC POOL PERMIT -RES
45.00 Plan Check Fee . . 3.75
Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 30.0000 EA ELEC PRIVATE SWIMMING POOL 30.00
----------------------------------------------------------------------------
Permit PLUMBING
Additional desc . .
Permit Fee . . . . 18.00 Plan Check Fee 3.75
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00
----------------------------------------------------------------------------
Special Notes and Comments
SPA ONLY PER APPROVED STRUCT STEEL
PLAN/HOA APPROVAL RECEIVED/ALARMS &
BARRIERS MUST BE IN PLACE PRIOR TO
PREPLASTER INSPECTION.
Fee summary Charged
----------------- ----------
-Permit Fee Total 168.00
Plan Check Total 63.90
Grand Total 231.90
Paid Credited Due
---------- ---------- ----------
.00 .00 168.00
.00 .00 63.90
.00 .00 231.90
�j
Illeirm"
,r( .ML' Wiw0�H
ite: 12/7/04 Time: 3x23 PM To, Kirk ® 17607776097,1500 9494501465 Page: 001-001
,I P
TRILOGY AT LA QUINTA
Al IAINTENANCE A SSD CIA TION
December 1, 2004
Mervin & Gerda Brandt, Trustees
P.O. Box 600096
San Diego, CA 92160
Property Address: 60727 White Sage Drive
Dear Marvin & Gerda Brandt:
We are pleased to inform you that your plans for a spa, barbecue, lighting, and landscaping, has been conditionally
approved by the Design Review Committee per the condition(s) listed on the attached Conditions of Approval form.
Additionally, there may be notes written directly on the plans that are being returned to yoL that contain additional
conditions that must be met. Please review your plans carefully for those changes (if any).
This approval does not constitute consent by the Association for the applicant to encroacl% trespass, or build on
any property other than that of the applicant. Please be advised that this approval does not relieve you from
obtaining any necessary building permits from the governmental agencies involved. .
It is strongly recommended that you hold your final payment to any contractor doing work on the exterior of
your home until such time that a Design Review Committee member has inspected your property and your
deposit has been refunded to you. If any damage has been caused by your contractor to common area property,
the Association will have the necessary repairs made and deduct the cost from your deposit. Therefore, it is
important for you to wait for the deposit refund before you pay your contractor in full.
Once you submit your Notice of Completion form, the time frame to get an inspection and a refund check to you
can vary between two to three weeks, depending on when it is received at the Trilogy La Quinta Santa Rosa
Club. Thank you for your -patience in this matter and for complying with the Association's policies and standards.
Sincerely,
For the Design Review Committee
(Bobbie Stone
Bobbie Stone
Association Business Manager
Enclosures
Professionally Managed by Action Property Management, Inc.
60-750 Trilogy Parkway, La Quinta, CA 92253
(760) 777-6059 (760) 777-6097 fax
www.actionlife.com
TRILOGY AT LA QUINTA
CONDIT ONS OF PROVAL
Properly Address � 2 Date Reviewed b Zt9 - 4/
Conditions of
Approval
Your plans have been approved, provided that you meet the items checked below:
1.
The patio cover material will be wood or wood like construction. Roofing materials shall
match the roof material of the dwelling or be open wood lattice.
2.
The color of the patio cover matches the home's stucco, trim, accent, fascia or white.
3.
Any patio cover or awning to be installed and attached to the home must be installed in
such a manner that it does not compromise the integrity of the water permeability of the
home.
4.
Due to the patio cover's size it must be constructed with variable heights or must be
constructed in two sections with a separation in between.
5.
The size of the patio cover is limited to the size of the proposed patio slab.
6.
The proposed retractable awning may not be a striped awnin;. It must be a neutral color
that blends with the home. Please submit a sample of the fabric.
7.
Obtain services of a state licensed professional for consultation.
8.
Obtain necessary building permits from the city of La Quinta, meeting setback
requirements per city code and maintain the existing drainap; .
9.
Maintain positive drainage in accordance with the Trilogy Design Guidelines (Section 3.8).
10.
The screen door must be the color of the house stucco or be black.
11.
Due to the rear yard modifications, an under ground drainage system day lighting at the
curb is required. See attached drainage plan and schematics.
12.
Pool, spa, fountain and air conditioning equipment shall be set back from the side yard
property line by at least five feet, and from the rear property dine by at least eighteen inches.
All equipment shall be located, screened, or recessed in a menner so as to not be viewable
from any lot or street and the noise from the equipment attenuated for the adjacent property
owners.
13.
The color of the proposed concrete is natural or a neutral tone.
14.
Maintain a minimum clearance of 18" for softscape along th-- rear property line.
15.
Maintain a minimum clearance of 12" for softscape along thy side yard property line.
16.Rear
yard may not exceed 70% hardscape and must have a minimum of 30% softscape,
measured from the rear building face of wall to the side property lines.
17.
Proposed planting meets with the Trilogy Rear Yard Minimum Planting Requirement
standards and all plants are included on the Revised Approved Plant List contained in the
Design Guidelines dated May 4, 2004.
18.
The proposed wall or iron work to match the exiting developer retaining wall in material,
style and color or shall be the Frazee Paint color specified in the guidelines.
X
19.
When work is completed, please submit Notice Of Completion form attached!
X
20.
See notes on plans (if any).
H/Drive Trilogy La Quinta, Architectural, Conditions of Approval Guidelines 8-9-04
WALL
STEEL
VERT.
THICKNESS
SPACING
DEPTH
5'-0"
P-6"
IN FEET
6„
#3
0'
Zo
6"#3
AT 12
7'-0"
6„
#3
I,
8'-0"
AT 12
8'-6"
b„
#3
2,
o
AT 12"
`
6"
#33'
_`3`3°
-• �` �
IO"
AT 12"
OR AS REQ'D BY CITY
6"
#3
4'
#3'S AT
AT 12"
STOP EXTRA STEEL
8 "
#3
5 r
6" O.C.
AT 6"
W
8.
#3
6 ,
AT 6"
10"
#37,
- 4z-
AT 6"
;..• 2' MIN
10' MAX
"
#3.
8
- - - - - '-"
'..
4"
CHANGED UNIFORMLY
z 1000#
0 12" SCHEDULE -1 PRE -CAST COPING MAX. CONC. DECKING APPROVED MASTIC EXIST. HOU;
o
RADIUS SCHEDULE �, OR BLK. WA
N = 3-#3 BARS - CONC. DECKING X EXPANSION JOINT CONC DECK FOOTING
POOL
DEPTH
SLOPE 1/8" TO
a U- 114` P d"
_ a
LT -
_3 a- Q _
1 TYPICAL BOND BEAM STEEL
WATER SURFACE
V-0"
4'-0"
1'-0"
5'-0"
P-6"
5'-6"
2'-0"
6'-0"
2'-6"
Zo
6"#3
VERT. BARS AT 12" O.C.
7'-0"
3'-6"
7'-6"
N
8'-0"
W
8'-6"
5'-0"
3" CLRn
#3 HORIZ. BARS AT 12" O.C.
o
_
`
#3'S AT
THROUGHOUT
_`3`3°
-• �` �
IO"
8'
OR AS REQ'D BY CITY
-
N
9'
#3'S AT
SEE DECKING NOTES
STOP EXTRA STEEL
#3'S AT
#4@6"
6" O.C.
6" O.C.
6' O.C.
W
- ° _
D CLR.
COMPACTED SOIL
EP LCLEAR FROM
N TYP. POOL BOTTOM
"'
- 4z-
PLACE FIRST.ADD'L #3 BAR
;..• 2' MIN
10' MAX
- - - - -
WALL THICKNESS TO BE -�
- --N
J`' _
EL
- - - - - '-"
'..
I.
CHANGED UNIFORMLY
AT 12" O.C. AS SHOWN
-
w
o
-
POOL
DEPTH
"R"
3'-6"
V-0"
4'-0"
1'-0"
5'-0"
P-6"
5'-6"
2'-0"
6'-0"
2'-6"
6'-6"
304"
7'-0"
3'-6"
7'-6"
4'-0"
8'-0"
4'-6"
8'-6"
5'-0"
FIN. GRADE
SEE SCHEDULE 2 TYP. BOND BEAM W/ 343 BARS
• WATER SURFACE -
-
#3. VERT. BARS AT 6" O.C. x Q - _ - _ „ „
3-#3 TYP. BOND Q w W I �I I I I l I, .� I I/2 X 3 FELT I I -1 i
Sy BEAM ,F #3 HORIZ. BARS AT 12' O.C. > o o li�IF
4<� 1. THROUGHOUT c� = Z _III _ -COMPACTED
p ;0 0 E N I FOR TYPICAL WALL SECTION
X /YIN 3" CLR. J m t- S�RCH SOIL AND REINF. SEE DETAIL f
h- Q COMPACTED o '� a a EXPANSION JOINT
SOIL Rq yp "." ONE STORY H0 SE, GF N N
o OR GARAGE FOUNDATION, �(/� 3A ALL DECKING ADJACENT TO WALLS
d OR 6 -FT. HIGH BLOCK WALL �CF� o OR PERMANENT STRUCTURES
10
;1� I oFFA 5 k "tom 1000 LB/FT MAX. LOAD /NF _ SHALL BE SEPARATED BY A 112"
' SII FNS \0° RPO S CEO3" CLR. Q ��„ MIN. JOINT OF NON -EXPANSIVE,
R1p �\ SEE NON -POROUS FELT OR SIMILAR MATERIAL.
PLACE ADD'L VERT. STEEL
II- `330 a IN WALL IN ACCORDANCE I
WITH SCHEDULE Z Jof SCHEDULE -2
Q =
•--- - - -- ---• - - - o - #3 AT 12" O.C.. �
0 Lu
INWAYS ''=� I � . � � �° � � 3' CSR � `�� �
IN POOL BOTTOM., ; �kr
FOR POOL DEPTH GTR. THAN CENTER ALL STEEL
IN GUNITE #3 AT 6' O.C. VERT.
. AD
5 D #3 BAR VERT. AT t
" - - - - "� , - - BARS IN RADIUS 33° MAX. w ....
6 O.C. AND LAP 12„
'moi. •- .. . .
- a .
. ..:
_ . +► :,
TYP. POOL REINFORCEMENT LLOW OR DEEP END RAMP 18" MIN.
I 18" MIN. Q�
T ANSlTI N BUILDING SURCHARGE BLANK MEANS NO SPECIAL THICKNESS OR
TRANSITION 3
REINF. REQUIRED.
12" SPECIAL ENGINEERING REQ`D
VERTICAL STEEL REQ'D FOR SURCHARGE LOAD
DEPTH'
X 0-3' TO 5'
0-5' TO 7'
0-7' TO !8'-6"
3'-0" MIN. #3 AT 4" O.C.
#3 AT 3` O.C.
#4 AT 3" O.C.
4'-0" MIN.
#3 AT 3" O.C.
#4 AT 3" O.C.
5`-0" MIN. -
#3 AT 4" O.C.
#4 AT 4" O.C.
6'-0" MIN.
#3 AT 4" O.C.
#4 AT 4" O.C.
POOL OR SPA
2'
3'
#3 TIES AT TOP
12"
VARIES
12"
0'
�I
I,
3 ,
12" 0. C.
6"
AND BOTTOM
6„
4'
#3'S AT
#3'S AT
6,1
5'
_X -BARS
12" O.C.
OF POOL WALL
6'
#3@6"
,
`
#3'S AT
#3'S AT
_`3`3°
-• �` �
IO"
8'
12" O.C.
12" O.C.
6" O.C.
9'
#3'S AT
3"
CLR. E
#3'S AT
#4@6"
6" O.C.
6" O.C.
6' O.C.
6-0-C.
- ° _
D CLR.
H/5
EP LCLEAR FROM
N TYP. POOL BOTTOM
"'
PLACE FIRST.ADD'L #3 BAR
;..• 2' MIN
10' MAX
EARTH -SIDE FACE OF WALL.
3" CLR
8'
- - - - - '-"
'..
I.
t:
AT 12" O.C. AS SHOWN
-
Z
-
ui
0
#3 HORIZ. AT
12 " O.C. (TYP.)
#3 AT 12" O.C. EXTRA • �-
3" CLR
ALL REINFORCING BARS TO LAP 40 BAR DIAMETERS AT SPLICES (#3 BAR = 18" LAP MIN.).
3" CLR
'
J
AN
- a I
#3 VERT. AT
3.
ALL REINFORCING AS SHOWN ON THE DRAWINGS SHALL BE SUPPORTED TO MAINTAIN
= w
jf H
o E$" MIN.
6 O.C. (TYP.)
•
�
_
LO
#3 VERT. AT
6 O.C. (TYP.)
a
_
7 -
•.
-
-iTi----•iTi-iii-i r i-7
#3 VERT. AT 6" O.C.
111 111:
•,
o
I I
#3'S AT
--ill
<O'`
e
"
•
o
w ,�
#3 HORIZ. AT 12" O.C.
12" O.C. H0R1Z.
#3'S AT 12" -
Q
°ti .
(TYP.)
(TYP.)
N
O.C. E.W. =1
>
VERTICAL STEEL: X -BARS EXPOSED FACE
#3'S VERT.
DE
2'
3'
4'
S`
° (I
._-
- _ - - _I (I
#3'S AT
0'
�I
I,
3 ,
12" 0. C.
6"
3" CLR
6„
4'
#3'S AT
#3'S AT
6,1
5'
4
12" O.C.
12" O.C.
6'
#3@6"
,
#3'S AT
#3'S AT
#3'S AT
_`3`3°
-• �` �
IO"
8'
12" O.C.
12" O.C.
6" O.C.
9'
#3'S AT
#3'S AT
#3'S AT
#3'S AT
#4@6"
6" O.C.
6" O.C.
6' O.C.
6-0-C.
MIN. WALL
VERT.
THICKNESS
6 O.C. TO 24
ABOVE POOL
BOTTOM
STL. SPCG.
° (I
._-
- _ - - _I (I
#3's AT 12" O.C.
EACH WAY (TYP.)
0'
�I
I,
6„
2'
6"
3" CLR
6„
4'
MIN. WALL
VERT.
THICKNESS
DEPTH
STL. SPCG.
IN FEET
6"
0'
6"
I,
6„
2'
6"
3'
6„
4'
#3@6"
a `
6,1
5'
#3@6"
COMPACTED �} 6" MIN.
8"
6'
#3@6"
FILL YP,� - - - -
10"
7,
#3@4"
_`3`3°
-• �` �
IO"
8'
#3@4"
,-'-L
12"
9'
#3@4"
,. , . O'
13„
10'
#4@6"
off
�,
PRE CAST COPING
GENERAL NOTES
1. THIS STANDARD STRUCTURAL PLAN MUST BE ACCOMPANIED BY A CLEAR PLOT PLAN SHOWING
POOL AND/OR SPA SHAPE, DEPTH AND DISTANCE TO PROPERTY LINES, SLOPES, RETENTION
BASINS, STRUCTURES, FENCES AND WALLS. PLOT PLAN MUST SHOW SURFACE DRAINAGE
AWAY FROM POOL.
2. REPRESENTATIVES OF THE FLYING BUTTRESS HAVE NOT INSPECTED THE SITE AND ARE
RELYING ON INFORMATION PROVIDED BY THE CONTRACTOR OR OWNER TO DETERMINE THE
APPLICABILITY OF THIS STANDARD POOL PLAN FOR THE ACTUAL SITE.
3. THIS IS A GENERIC POOL PLAN, DESIGNED FOR POOL CONSTRUCTION IN POROUS, WELL -DRAINED,
NON -EXPANSIVE, COMPACTED OR NATIVE SOIL IT IS THE RESPONSIBILITY OF THE HOMEOWNER
OR POOL CONTRACTOR TO VERIFY SOILS CONDITIONS PRIOR TO CONSTRUCTION. '
4. THIS PLAN IS NOT SUITABLE WHERE POTENTIAL EXISTS FOR DIFFERENTIAL MOVEMENT FROM
DISSIMILAR SOIL CONDITIONS UNDER THE POOL, SUCH AS CUT -FILL TRANSITIONS.
5. SHOULD SITE CONDITIONS VARY FROM THOSE COVERED BY THIS STANDARD POOL PLAN, IT IS
THE RESPONSIBILITY OF THE CONTRACTOR OR THE HOMEOWNER TO OBTAIN APPLICABLE
SPECIAL ENGINEERING DETAILS PRIOR TO CONSTRUCTION.
6. THE FLYING BUTTRESS RECOMMENDS THAT THE HOMEOWNER OR POOL CONTRACTOR OBTAIN
A SOILS REPORT.
7. THE STANDARD POOL PLAN IS NOT INTENDED TO BE APPLICABLE TO NON-STRUCTURAL ITEMS
INCLUDING BUT NOT LIMITED TO PLUMBING, ELECTRICAL, GAS PIPING, FENCING, AND CONCRETE
DECKING.
8. THIS PLAN IS NOT VALID WITHOUT ADDITIONAL SURCHARGE DETAILS WHEN THE FOLLOWING
CONDITIONS APPLY PER UBC SECTION 1806.5.3 AND 1806.5.4 FOR POOLS LOCATED CLOSE TO
THE TOP OF SLOPE.
LESS THAN LESS THAN 7'-0"
`D' POOL DEPTH 'X' OR 'Q`* LESS
OR H/4. � THAN H/6.
f�I-
l_ _
FOR RAISED PLANTER CONC. DECKING -
VERT. s
SLOP TO DRAIN o IN FEET PTH FIN. GRADE *DOES NOT RAPPLA IF '0'
WATER SURFACE 1S GREATER THAN 20' III
x 0' a
-� �� SCHEDULE- 3 SOIL CONDITIONS -
_ _ a #3 VERT. BARS AT 12 O.C.
3-#3 TYP. I a< m WATER
cli3-#3
BOND BEAM SURFACE
DI
D2
3'-0"
- - - - - - --
TYP. #3 HORIZ. BARS AT 12" O.C.
- III.
4'-0"
4"
BOND BEAM 6• THROUGHOUT
#3 AT 6" O.C.
36" DIAM.
z
W
2'
5.
#3 VERT. BARS AT 12=0.0 _ -
m
a `
12"
3' CLR.
'NEW'
COMPACTED �} 6" MIN.
w
m
3'
FILL YP,� - - - -
SOIL
"'
-
6'
_`3`3°
-• �` �
6.
4'
3" CLR. #3 HORIZ. BARS AT 12" O.C.
,-'-L
w
1
THROUGHOUT
,. , . O'
JOB SITE.
RA�wS EpvLE
POOL
DEPTH
,H,
DI
D2
3'-0"
3"
3"
4'-0"
4"
4"
#3 AT 6" O.C.
36" DIAM.
2609#
48" SQ.
NAT. GRADE--j,,e
5.
I. SOIL SHALL HAVE A MINIMUM BEARING VALUE OF 1000 PSF.
2. EQUIVALENT FLUID PRESSURE = 35 PCF MAXIMUM.
3. RAISED PLANTERS LOCATED ADJACENT TO THE POOL WALL EXERT A SURCHARGE LOAD ON
THE POOL STRUCTURE THAT EXCEEDS 35 PCF. SPECIAL ENGINEERING IS REQUIRED FOR
THESE CONDITIONS.
4. WHEN GROUNDWATER IS ENCOUNTERED DURING EXCAVATION OR WHEN THE POOL DEPTH
EXCEEDS THE LOCAL WATER TABLE, A HYDROSTATIC RELIEF VALVE IS REQUIRED IN THE
i w^o • TRANSITION 4. MINIMUM CLEARANCE BETWEEN PARALLEL BARS IS 2-1/2".
VARIES FILL ADJACENT TO POOL - DEEP END
Naa 18" MIN. %
GUNITE SPECIFICATIONS (PNEUMATICALLY PLACED CONCRETE)
TRANSITION ,-•, --_� oS PoUR
INFINITY EDGE RAISED $OND BEAM �a�¢REps�a��q i. MINIMUM COMPRESSIVE STRENGTH AT -DAYS: F`c = 250
5 " 6 ,�� �5� O�
ELEVATED POOL WALL �� �` C2� 2. GUNITE MUST BE IN CONFORMANCE WITH UBC SEC. 1924 AND SHALL CONSIST OF
I PART PORTLAND CEMENT TO 4-1/2 PARTS SAND.
Cc NO. 33446 ` rn 3. CEMENT SHALL CONFORM TO ASTM C-150.
4. USE TYPE V PORTLAND CEMENT IN AREAS WITH MORE THAN 2% SULFATE CONTENT
AND AS DIRECTED BY LOCAL BUILDING CODES.
P BOULDER WT.
' g= (MAX. WT. = l85 PCF) CAL,` 5. KEEP GUNITE DAMP CONTINUOUSLY FOR 14 DAYS.
CONSTRUCTION CODES wy 6. ALL INTERIOR SURFACES OF POOL AND SPA SHALL BE COATED WITH A WATERPROOF
- - U StLJCA PLASTER PER NATIONAL SPA AND POOL INSTITUTE STANDARDS.
CONC. DECKING PRE -CAST COPING LEVEL BOND BEAM _ 6" "� �' BUILDING AND SAFETY: UBC 1997
CONCRETE (GUNITE OR SHOTCRETE): O� Poc1R IN-PLpGE �Alj8-95 7. GROUNDING PER N.E.C. OF THE STRUCTURAL REINFORCING MUST BE INSTALLED
FIN. GRADE 12" W/ GROUT BEFORE DECK #3 BARS AT 6" 12" w Q- 995 PRIOR TO PLACEMENT OF GUNITE.
WATER SURFACE APPROVED SEAL & + POURING SLAB O.C. EA. WAY �` `"`+ m I- STANDAR RESIDENTIAL INGROUND SWIMMING POOL A 15 I
EXPANSION JOINT ;� �` � ;, �� . �� . Q , 8. GUNITE SHALL BE PLACED AGAINST UNDISTURBED SOIL OR BUILDING DEPARTMENT
3-1/2 CONC. SLAB PAD SIZE W < STANDARD FOR PERMANENTLY INSTALLED RESIDENTIAL SPAS: ANSI/NSPI-3 1999
_ ° APPROVED 9 TE
_ -j 8"MIN. THICKNESS n W PLASTER: NATIONAL PLASTERERS COUNCIL, TECHNICAL MANUAL, AP Rov 0% COMPACTED FILL
I! -III -III TI - ST IN
3-#3 BARS AT 3" CLR. x ° a ° ° - - MASTIC ST BARS F. o ;o REVISED JANUARY 1998 DECKING RECOMMENDATIONS
_ _ _
BOND BEAM �+ 1, TYP. x = iv a :I I {-I i 1= `° 3" CLR. o WORKMANSHIP STANDARDS: NATIONAL SPA AND POOL INSTITUTE, JUNE 1996
'n #3 VERT. BARS AT 12" O.C. _ Q --� I- o TILE -� a 1- 1. DECKING CONSTRUCTION IS SHOWN AS RECOMMENDED MINIMUM CONSTRUCTION AND
0 0 TILE LAP 24 0 = AMERICAN NATIONAL STANDARD FOR PUBLIC SPAS ANSUNSPI-2 1999
0 #3 BARlZ. BARS AT ;,� o � 3-#3 BARS I j ,� :e .' f � X30 DOES NOT DEMONSTRATE A SYSTEM THAT WILL RESIST HEAVING DUE TO SOIL EXPANSION.
AT BOND BEAM I 3-#3 BARS FLR. �, AMERICAN NATIONAL STANDARD FOR PUBLIC SWIMMING POOLS ANSUNSPI-11 O�E� THE FLYING BUTTRESS DOES NOT ASSUME ANY LIABILITY REGARDING DECK CONSTRUCTION.
w 12" O.C. THROUGHOUT 6" IS LB. FELT OR " ° , t,
r PLASTER �� ANY APPLICABLE LOCAL ORDINANCES�'�iON E�QQR ��
a 'NEW' FILL TYP. POOL BOTTOM `�.t 4 MIL. VISQUEEN -� �Q� '(Yi �� 2. THE POOL DECK AND YARD AREA SURROUNDING THE POOL SHALL SLOPE AWAY FROM THE
> �� ° - 4 D �. _3' CLR. A �E ����'�RGE�`PRD PRE EQU�.F•0 POOL STRUCTURE AND PROVIDE 2.0% SURFACE RUNOFF.
NAT. GRADE. • .,"�_.:.�,... �s,� - PLASTER \ �j\�.�-�EPN� ��E C P sC� 3. EXPANSION JOINTS IN DECKS AND COPING SHALL BE MADE WATERTIGHT WITH AN APPROVED
FOR POOL 2' TO 5' DEEP TABLE I HEALTH AND SAFETY NOTES Ns AOR
1E PERMANENT RESILIENT SEALANT.
C„�1, ,
18" MIN.
TRANSITION
12"
BOULDER SIZE
'I
PAD SIZE "W"
"D"
5
-
777#
DEEPEST LOCATION OF THE POOL
STOP FIRST ADD'L
#3 AT 6" O.C.
36" DIAM.
2609#
48" SQ.
NAT. GRADE--j,,e
5.
THE POOL DECK AND YARD AREA SURROUNDING THE POOL SHALL SLOPE AWAY FROM THE POOL
VERT. STEEL--
-
12"
#3 AT 6" O.C.
STRUCTURE AND PROVIDE 2.0% MINIMUM SURFACE RUNOFF.
PLACE ADD'L #3 BAR
AT 4" O.C.
"'
-
6'
_`3`3°
-• �` �
6.
CONTRACTOR OR HOMEOWNER SHALL VERIFY ALL FIELD CONDITIONS AND DIMENSIONS AT THE
STOP SECOND ADD'
- --- -
-6R-#4 6" O.C.
,. , . O'
JOB SITE.
- VERT. STEEL
off
�,
PER TABLE AT LEFT
7'
- ° _
STEEL SPECIFICATIONS
EP LCLEAR FROM
N TYP. POOL BOTTOM
"'
PLACE FIRST.ADD'L #3 BAR
��,
EARTH -SIDE FACE OF WALL.
8'
- - - - - '-"
'..
I.
REINFORCING BARS: ASTM A-615, GRADE 40, FY= 40 KSI.
AT 12" O.C. AS SHOWN
-
- -
#3 AT 12" O.C. EXTRA • �-
2.
ALL REINFORCING BARS TO LAP 40 BAR DIAMETERS AT SPLICES (#3 BAR = 18" LAP MIN.).
'
TYP. POOL BOTTOM
VERT. STL. IN RADIUS .
3.
ALL REINFORCING AS SHOWN ON THE DRAWINGS SHALL BE SUPPORTED TO MAINTAIN
= w
o E$" MIN.
3" MINIMUM CLEARANCE BETWEEN STEEL AND EARTH.
i w^o • TRANSITION 4. MINIMUM CLEARANCE BETWEEN PARALLEL BARS IS 2-1/2".
VARIES FILL ADJACENT TO POOL - DEEP END
Naa 18" MIN. %
GUNITE SPECIFICATIONS (PNEUMATICALLY PLACED CONCRETE)
TRANSITION ,-•, --_� oS PoUR
INFINITY EDGE RAISED $OND BEAM �a�¢REps�a��q i. MINIMUM COMPRESSIVE STRENGTH AT -DAYS: F`c = 250
5 " 6 ,�� �5� O�
ELEVATED POOL WALL �� �` C2� 2. GUNITE MUST BE IN CONFORMANCE WITH UBC SEC. 1924 AND SHALL CONSIST OF
I PART PORTLAND CEMENT TO 4-1/2 PARTS SAND.
Cc NO. 33446 ` rn 3. CEMENT SHALL CONFORM TO ASTM C-150.
4. USE TYPE V PORTLAND CEMENT IN AREAS WITH MORE THAN 2% SULFATE CONTENT
AND AS DIRECTED BY LOCAL BUILDING CODES.
P BOULDER WT.
' g= (MAX. WT. = l85 PCF) CAL,` 5. KEEP GUNITE DAMP CONTINUOUSLY FOR 14 DAYS.
CONSTRUCTION CODES wy 6. ALL INTERIOR SURFACES OF POOL AND SPA SHALL BE COATED WITH A WATERPROOF
- - U StLJCA PLASTER PER NATIONAL SPA AND POOL INSTITUTE STANDARDS.
CONC. DECKING PRE -CAST COPING LEVEL BOND BEAM _ 6" "� �' BUILDING AND SAFETY: UBC 1997
CONCRETE (GUNITE OR SHOTCRETE): O� Poc1R IN-PLpGE �Alj8-95 7. GROUNDING PER N.E.C. OF THE STRUCTURAL REINFORCING MUST BE INSTALLED
FIN. GRADE 12" W/ GROUT BEFORE DECK #3 BARS AT 6" 12" w Q- 995 PRIOR TO PLACEMENT OF GUNITE.
WATER SURFACE APPROVED SEAL & + POURING SLAB O.C. EA. WAY �` `"`+ m I- STANDAR RESIDENTIAL INGROUND SWIMMING POOL A 15 I
EXPANSION JOINT ;� �` � ;, �� . �� . Q , 8. GUNITE SHALL BE PLACED AGAINST UNDISTURBED SOIL OR BUILDING DEPARTMENT
3-1/2 CONC. SLAB PAD SIZE W < STANDARD FOR PERMANENTLY INSTALLED RESIDENTIAL SPAS: ANSI/NSPI-3 1999
_ ° APPROVED 9 TE
_ -j 8"MIN. THICKNESS n W PLASTER: NATIONAL PLASTERERS COUNCIL, TECHNICAL MANUAL, AP Rov 0% COMPACTED FILL
I! -III -III TI - ST IN
3-#3 BARS AT 3" CLR. x ° a ° ° - - MASTIC ST BARS F. o ;o REVISED JANUARY 1998 DECKING RECOMMENDATIONS
_ _ _
BOND BEAM �+ 1, TYP. x = iv a :I I {-I i 1= `° 3" CLR. o WORKMANSHIP STANDARDS: NATIONAL SPA AND POOL INSTITUTE, JUNE 1996
'n #3 VERT. BARS AT 12" O.C. _ Q --� I- o TILE -� a 1- 1. DECKING CONSTRUCTION IS SHOWN AS RECOMMENDED MINIMUM CONSTRUCTION AND
0 0 TILE LAP 24 0 = AMERICAN NATIONAL STANDARD FOR PUBLIC SPAS ANSUNSPI-2 1999
0 #3 BARlZ. BARS AT ;,� o � 3-#3 BARS I j ,� :e .' f � X30 DOES NOT DEMONSTRATE A SYSTEM THAT WILL RESIST HEAVING DUE TO SOIL EXPANSION.
AT BOND BEAM I 3-#3 BARS FLR. �, AMERICAN NATIONAL STANDARD FOR PUBLIC SWIMMING POOLS ANSUNSPI-11 O�E� THE FLYING BUTTRESS DOES NOT ASSUME ANY LIABILITY REGARDING DECK CONSTRUCTION.
w 12" O.C. THROUGHOUT 6" IS LB. FELT OR " ° , t,
r PLASTER �� ANY APPLICABLE LOCAL ORDINANCES�'�iON E�QQR ��
a 'NEW' FILL TYP. POOL BOTTOM `�.t 4 MIL. VISQUEEN -� �Q� '(Yi �� 2. THE POOL DECK AND YARD AREA SURROUNDING THE POOL SHALL SLOPE AWAY FROM THE
> �� ° - 4 D �. _3' CLR. A �E ����'�RGE�`PRD PRE EQU�.F•0 POOL STRUCTURE AND PROVIDE 2.0% SURFACE RUNOFF.
NAT. GRADE. • .,"�_.:.�,... �s,� - PLASTER \ �j\�.�-�EPN� ��E C P sC� 3. EXPANSION JOINTS IN DECKS AND COPING SHALL BE MADE WATERTIGHT WITH AN APPROVED
FOR POOL 2' TO 5' DEEP TABLE I HEALTH AND SAFETY NOTES Ns AOR
1E PERMANENT RESILIENT SEALANT.
C„�1, ,
18" MIN.
TRANSITION
12"
BOULDER SIZE
'I
PAD SIZE "W"
"D"
STEEL "X" BARS
24" DIAM.
777#
36" SQ.
12"
#3 AT 6" O.C.
36" DIAM.
2609#
48" SQ.
12"
#3 AT 6" O.C.
48" DIAM.
6198#
60" SQ.
12"
#3 AT 6" O.C.
L POOLS WITH DIVING BOARDS SHALL MEET THE NSPI DIVING POOL �AE S �A t11�Q �dNs� 4. ALL DECKING ADJACENT TO WALLS OR PERMANENT STRUCTURES MUST BE SEPARATED WITH
AND OR LOCAL CODES. X10 .lp A 1/2" MIN. NON -EXPANSIVE, NON -POROUS FELT OR SIMILAR MATERIAL
A
2. PUBLIC POOLS REQUIRE COUNTY HEALTH DEPARTMENT APPROVAL AND PROVISIONS FOR 5. LEVEL TOP OF BOND BEAM WITH ACRYLIC GROUT AND PLACE 15# BUILDING FELT OR 4 MIL.
ASSISTIVE DEVICES FOR THE DISABLED. VISQUEEN ON TOP. DECKING MATERIAL MUST NOT TOUCH COPING OR BOND BEAM.
FOR POOL 5'-6" TO 8' DEEP TABLE 2 3. SIGNS AND SAFETY EQUIPMENT SHALL BE INSTALLED IN ACCORDANCE WITH LOCAL CODES. HOMEOWNER
FILL ADJACENT TO POOL - SHALLOW END STANDARD COPING AND TILE TYPICAL CANTILEVER DECK
8 9 10
BOULDER SIZE
'I
PAD SIZE "W"
"D"
STEEL "X" BARS
24" DIAM.
777#
36" SQ.
14"
#3 AT 3" O.C.
36" DIAM.
2609#
48' SQ.
14"
#3 AT 3" O.C.
48" DIAM.
6198#
60" SQ.
14"
#4 AT 6" O.C.
4. POOL FENCING SHALL BE INSTALLED 1N ACCORDANCE WITH ALL LOCAL CODES.
5. PRIOR TO FILLING, THE POOL AND/OR SPA SHALL BE COMPLETELY ENCLOSED BY A 5 -FT. P GUNITE DAMP CONTINUOUSLY FOR 14 DAYS AFTER INSTALLATION.
HIGH FENCE AND GATES WITH NO OPENINGS GREATER THAN 4". GATES TO BE ajjjj4'TAD
SELF-CLOSING AND SELF -LATCHING WITH LATCH A MIN. OF 5 -FT. ` ,`� 0 NOT TURN POOL OR SPA LIGHT ON WHEN POOL 1S EMPTY.
V T.DO OT USE A BLACK RUBBER HOSE WHEN FILLING POOL (IT STAINS THE PLASTER). TIE A
C1
BOULDER ON BOND BEAM VARIES FROM LOCAL CODES, THE LOCAL CODES SHALL PREVAIL. G &SA RA ON THE END OF THE HOSE TO DISTRIBUTE THE FLOW EVENLY ON THE NEW PLASTER.
I I 6. POOLS SHALL BE EQUIPPED WITH A FILTERING SYSTEM AND A DRAI BUt`-•1)=N ��vle� TRE S AND LUSH LANDSCAPING LOCATED CLOSE TO THE POOL MAY EVENTUALLY PRODUCE
7. OBTAIN ELECTRICAL 'AND PLUMBING PERMITS ALONG WITH POOL BUIL ING PEAPP SlfkjjrTlo ROO S THAT CAN PUSH AGAINST THE POOL WALL OR CAUSE THE DECKING TO LIFT. THE
12" 8. ALL EQUIPMENT SHALL BE INSTALLED PER MANUFACTURERS RECOMM NDATIffGW9 TN1
9" OR WIDER BOND' BEAM MAY CRACK AND THE TILE MAY POP OFF AS A RESULT. INSTALLATION OF A
MIN. ACCORDANCE WITH LOCAL REGULATIONS.
' 6" MIN. 13Y ei GUARD WILL HELP PREVENT THIS FROM OCCURRING..
2-#3 BOND BM. ? 9. ANY METAL WITHIN 5 -FT. OF POOL EDGE MUST BE GROUNDED PER
DECK OR CAP
• BEND BOND _
10'-0" IMI "
Z-#3 N. NOTE:
�
BEAM STEEL i ' WATER SURFACE I `,T OT E . BY THE USE OF THIS PLAN THE USER ACKNOWLEDGES THAT HE/SHE HAS READ
1=1 L BARS { 1. 1 1 1 a WATER LEVEL
z AROUND _ #3 HORIZ. ,..� D UNDERSTANDS ALL OF THE NOTES INCLUDED HEREIN.
III . SII + 111 -. ,-, AN
III NICHE Il 18' N BARS @ 12" O.C. ,a x
a I .THIS PLAN IS .THE WORK OF THE ENGINEER AND SHALL NOT BE REPRODUCED, COPIED, OR OTHERWISE USED
6" MIN. N #3 AT 6" O.C. ►� E Q 5' R=2'-6" MAX.
�. WITHOUT HER PERMISSION.
NEC APPROVED SECTION 3 N VERT. STEEL @ TOP OR ' ,h R-1'-0' MIN.
CONDUIT STRAIGHT WALL '�` TOE OF DOWEL INTO EXISTING z THIS PLAN IS INTENDED FOR USE IN THE FOLLOWING CITIES ONLY:
Z .1. 3 -0'
6 MIN. 1 " #3 VERT. BARS ..CID SLOPE POOL WALL OR � °, °. : a
!8 LAP AT 12 O.C. ��. b ° " ° SPA CLR. ADD #3 BARS AT 12" O.G LONGITUDINAL NEW = - PALM DESERT, PALM SPRINGS, CA TY, RA GE, THOUSAND MS,
FLOOR WITH CATHEDRAL CI RANCHO MIRA OUSAND PA
y • ° 03 5' AT TRANSITION SPA CEMENT p� ���I LA QUINTA, DESERT HOT SPRINGS, INDIAN WELLS, YUCCA VALLEY AND INDIOL
RECESSED' `, --�- .... �? FLOOR ADHESIVE x 4 p I1L'"
LIGHT ° , I I o q REINFORCE GUNITE WITH #3 BARS a F <. a .0
#3 AT 6" O.C. ...-^ NOTE: PROVIDE (2) ANTI -VORTEX -III 9 .y Z�-,
BOTH WAYS _ -. DRAINS. ONE LOCATED IN SPA FLOOR 6 TYP. FLOOR`"• �Z PROVIDE {2) ANTI -'VORTEX DRAINS @ 12' O.C. BOTH WAYS 6�Q �p�,0FESs�O�
6 MIN. SECTION W/ #3 �� WITH NSPI-APPROVED SUCTION COVERS. - Y I II I PA STEEL REINFORCING PLAN Q�0 `tea p0F q�
AROUND NICHE AND ONE LOCATED ON SIDE OF SPA SEAT T- o e , I POOL AND S �5 �, F�
" - @I2 O.C. E.W. =J o LOCATE DRAINS EQUAL DISTANCE V) l `� a
I I " 3" ABOVE SPA FLOOR, PER IA.PMO POOL IIr NOTE: INSTALL HYDROSTATIC VALVE AND j <v c
18 MIN, APART FROM OUTLET PIPE
AND SPA CODE. SEE TYP. POOL ROCK PACK AT LOW POINT WHERE REQUIRED �, m
- LAP (TYP.) - 6' MIN. O 2-#3 BARS � i i :��., EXISTING POOL � No. 33446 m
SECTION BY HIGH WATER TABLE. I _ WALL POOL CONT CTOR: HOMEOWNER: M '$Q�,�D� Ex -30-0
/ ,.. RECESSED
TYPICAL SPA' SECTION t` LOCATE MAIN DRAINS AT LOW POINT. i I " 0tIJ1�GR$l) ILvzR� 1'
LIGHT MAIN DRAIN PIPES SHALL NOT #3 DOWELS AT 12 O.C. VERT. AND ADDRESS: (�.�2� W0I it SPt4c D�
I �+ ALTERNATE:. • • � �. '[ .
ELEVATION - - NICHE PLAN ENCROACH INTO GUNITE SHELL. HORIZ. (MAX. TYP.) OR USE -OFC
CAL�FO
- T -r PA ADJA ENT T P OL EXPOSE AND LAP
�.a �J1►r� ,
... STEEL SPACING IN DETAIL #1 FOR POOL q CQr Q2253`"� „�
I5 S C O O 8T MIN. NAND LA `� :DEPTH GREATER THAN 4 FEET.
i I I SKIMMER NICHE DETAIL PLAN VALID ONLY WITH
SECTION AT LIGHT BOX 13 TYPICAL LONGITUDINAL SECTION RETROFIT TIE STEEL DATE: BLUE WET STAMP AND
IZ I6 I7 ENGINEER'S SIGNATURE
JOB NO.: TEL. NO.: t�OO-rh-7 is IN BLACK INK ON PLAN
/1 CREATED 08 OCTOBER 2004
OWNERBUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California a ---id to have a business license
from the City or County. They are also required by law to put their license number cn all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and tie work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these ris_-cs are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents`
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' Mate License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Cal Tampico
La Q60 17ID7
a, C 92253
FAQ 7707 -7011 /
OWNER'S SIGNATURE/DATE /
PROPERTY ADDRESS
,o1- Ab
PERMIT NUMBER(S)