9493 (BLCK)44
P.O. BOX 1504 N o . 9491
Building 44-185 17TLPMA LA QUINTACCAL FORNIA 92253 ,,
Address BOOL EQUIPMUT
WALL +
Owner �
PATRYQI�
Mailing BUILDING: TYPE CONST. OCC: GRP.
Address SAM A.P. Number
CityZip Tel.
LA QiTIP1'iA, CA 92253 340-9000 Legal Description
Contractor Project Description POOL EQUIPMENT WALL
CALIFORwrA POOLS
Address 20 • LONG R 5 " `AIOi3 b '
419 10 BOARDWALK
City Zip Tel.:
PALH DESP.RT192260
State Lic. City
& Classif. 185102o Lic.# 355 Sq. Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I arm- icensed under provisions of Chapter 9 (commencing with Section
7000) of Division of the B'usinye�5sand Professions Code, and my license is in full force and
effect:
SIGNATURE kDATE
OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following. $108.25 �
reason: (Sec. 7031.5,Business and, Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such-permit to rile a signed statement that he is licensed pursuant to PERMIT -
the provisions o/ the Contractor's License Law, Chapter, 9 (commencing with Section 7000) o/
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 - Plan Chk. Dep.
subjects the applicant to a civil penally of not more than rive hundred dollars.($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will Plan Chk.. Bal.
do the work, and the structure'is not intended or offered for sale. (Sec. 7044, Buisness and Const.
$25{%�
-Professions Coder 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, Mech.
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-budder. will have the burden EIBCtrIC3I
of proving that he did not build or improve for the purpose o/ sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law �f
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. • 25
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
Grading
❑ I am exempt under Sec. B. 8 P.C. for this reason
Driveway Enc.
Date Owner Infrastructure
11, t
WORKERS' COMPENSATION DECLARATION ,� 1
I hereby affirm that I have a certificate of consent to self-insure, or a certificate.of - t�
Worker's o pensation Insurance, or a certifop y hergQf. Sec 3800 Labor Code.)
Policy Nb •� Company Yl 1 a5> 14N Zj u timet UE N4 I-
❑ Copy is filed with the city.. ❑ Certified copy, is hereby furnished.
TOTAL $25.25
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the Penn# is for one hundred dollars ($100) valuation
-
or less.)
I certify that the performance of thg work for w ich this permit is issued, I shall not , , r n; r
employ any person in any manne so as [o become ubject to the Workers' Compensation vo ,tom), , ry s ;vsa j g ti� _ 25 A `5
Laws of California. p �j'� �Wj i7 !I jf33 �t NN A
Date
l i "d d' f OrNner JYl )
. NOTICE To APP (CANT. If, iter making'-this Certificate o/ Exemption you-should became ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shaft be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
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.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
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. Issued by: Date Permit
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. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
IST FL. SO. FT. ® $
UNITS
SLAB GRADE
2ND FL. SO. FT.
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SO, FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
GAS (ROUGH)
DRAINAGE PIPING
WALL SO. FT.
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SO FT ®
TEMP. POLE
URINAL
ESTIMATED CONSTRUCTION VALUATION $
GROUT
WATER PIPING
NOTE: Not to be used as property tax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
'FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
i
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 ® 11/. c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR ® 3/ac
HOUSE SEWER
LATHING
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 GOND. 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 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
i
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
INAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATUREWINITIALS
GARDEN WALL FINAL