15485 (RPL)44Q
r P.O. BOX 1504 No. 15485
Building 78-495 CALLE TAMPICO
Fi Address 47-815 Via Firenze LA OUINTA, CALIFORNIA 92253
OwnerCentury Noes
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address -1535 South nD" St.
A.P. Number
City, Zip Tel.
San Bernard:in r CA 924081(909)381-6007 Legal Description
Contractor Project Description Pool and Spa
Dodson Pools
Address
68-805 A Perez Rd. E9 -
c6tailedral Citi elpCA 921,234 TeS24-1232
State Lic. City
& Classif.. 574127 Lic. # 1044 Sq. Ft. No. No. Dw.
ArchEngr.
Size Stories Units
., ,
Designer t
Address Tel.
City IZip � I State
.Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereliyy affirm that I am licensed under provisions of Chapter 9 (commencing with Section
A 7000) of,Division 3 of the Business and Professions :Code, and myrllcense+isAmfull,force and
effect f
GNATURE -` DATE
OWNER -BUILDER DECLARATION `
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, pnor.to Its issuance also
requires the applicant for such permit to Ole a signed statement that he is licensed pursua-It to
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
subjects the applicant to a civil penalty of not more than rive hundred dollars (8500).
❑ 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 appy to an owner or 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 contractors) pcensed pursuant to the Contractor's cense Law.)
❑ 1 am exempt under Sec B. & P.C. for this reason
Date Owner
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
tT 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 ($100) valuation
or less.)
I certify that'in the performance of thF 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_ f, 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.
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. F
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.,
Signature of applicant— —Date—
Mailing
ateMailing Address
City, State, Zip
New ❑ Add ❑ Alter ❑ Repair ❑
Demolition ❑
" y
.
Estimated Valuation $12.0'000.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
87.75
Const.
135.00'
Mech.
24.00
Electrical
45.00
Plumbing
27.00
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
3T5 r ,j! •--
REMARKS
ZONE: BY: . /
Minimum Setback Distances: /
Front SetbackIr"p Center,brie
Rear Setback from Rear Prop. Line
Side Street etback from � enter Line
Side Setback fromProperty Line�� �
FINAL DATE $y INSPECTOR!2
Issued by: Date
Validated bv:
.. Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FFJES.
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO. FT. ®
CAR P. SO. FT.
WALL SO. FT. ®
SO. FT. ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
SLAB GRADE
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
SEWER OR SEPTIC TANK
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
ROCK STORAGE
LAUNDRY TRAY
AIR HANDLING UNIT CFM
GAS (ROUGH)
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
WATER HEATER
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1 Vi c
SEWAGE DISPOSAL
SO.FT.GAR ® V4c
HOUSE SEWER
Q
FINAL INSP.
GRADING
cu. yd.
$ Plus -X$-=$
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
--j
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLU
05,S
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)
/1
7'
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
Q
FINAL INSP.
GRADING
cu. yd.
$ Plus -X$-=$
LUMBER GR.
FRAMING
FINAL INSP.
ROOFING
//
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL
OCY,Tra Ebh,T'�� 81'LTESH=L�
sj
L=`iEL SEATI ` !.T11 t S Z_ GROUP 3 _I
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WA IN CRA IN Yl' S
} .. SKIMA^E; kV If1Fl DUAL PORT__ I
C4'Gtl_ti'A4EFUK SPA 1
'CHECK Is ��- - -1EATER _LkARS_SIZE ?',0,1300 BT11 -
6 6"R J , — i tiQ
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ATM A i . S A A. FTCN.
1.� CONTR. UCRI ,-nio: a=suck-
- -
4 i s re3po�'si'�il ty ur �'a n=ge to '
curbs. sinew=lvs,'drnrerraps.
„✓ _ cement slabs, s'-urers-
1t Iav;ns.treFs: fence3, rcu.inirG ' - 0
A P , r \CrECl: lS y' j i ' Walrs, sprinklers, te.e :hone ire;
...��� yf r
mum !T x • or ;:Kubs. Whey access is made r
aw
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'�, '. ,+ r► r�t�'. 1 x - ' - i through a n�i h_o''s property it is- _
PCLSL Unde_rskutxf ih�t o
y u the z-wnpr,
o.R ha„e that rr•�ighbor s perrtrissbn
*• - t _ `� , - an ao7(me f..il resporsifJil ty.
-� �� -- x>r�� S r a�Ce -fav
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city: i:a l)iD. �•d:..
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