9805-076 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
c,haA& (commencing with Section 7000) of Division 3 of the Business and
_Professionals Code, and my License is in full force and effect.
License # Lic. Class 5 Exp. Date
Zae'✓•i --Ir Signature of Contractor -���} • ^ 1' �� `� ' f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & Professionals Code).
( .) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
,,Code).
() I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S 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
Seion 3700 of the Labor Code, for the performance.of the work for which this
permit is, issued. My workers' compensation insurance carrier & policy no. are:
Carrier t31a'� Policy No.� 7
(This section need not be completed if the permit valuation is for $100.00 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, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the.Labor
Cgfje, I shall`forthwith comply with those,provlslons.
ate: M/> �f°� Applicant'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code,interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and . restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person of
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is -
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for
inspection purposes.
pSignature (Owner/Agent)
BUILDING PERMIT PERMIT# : " °°NTR°`#
DATE VALUATION LOT 980.5-0715. TRACT
7114
J
S9.500.00
JOB SITIY
ADDRESS
53•-945.AVT.01114R CsON
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Mit. t4.- R5. SEIe'I"G °"
TROPIC POO - .
X3-945 AVE, OBREGON
k' 1.E1OX 1772
LA QUID TA CA 922`53
INDIO CA 92202
t
(769)347-21218 C BL#
USE OF PERMIT
POOL ONLY,NO:IFEA I ER ALARMSI3AMERS .A€ F TO BE ORkATIOMAJ.
# '
PRIOR TO F�Nt CAP, ;PR:E-PLA;$TER INSP1-.C`T16N. POOT 1:�t"AV '1.[033
5114ATI "ATZ ORT)V.0 a F11.1 STIVRTIVRn PR 1QR TO 17 •C,1tNT R
POOL ANIXOR SPA, 915M.00 LS MAY 1`81998
,;IT'Y OF LA QUINTA.
�{�Q� ey��f` p ^� y �+P1C� �y �+ erip�r �yx�s��` a�rlp,f
Irr,7.p.1)oi.i%l i�.�� S..ilS" O C�rL+S W.if a,.0. ,71.119
PERMIT FEE SUMMLARY
Pf—W CHECK: FEE 101.-000-439-31$ $76,09
C0NS'1RU( TION FEE 101-000-4.18-000. 17.00
ELECTRICAL FEF --: POOL .. 1011=00.0420.000. �ts.fti
PLU4tWtNO F611.• POOL 101-000-4.19.-000 $2?.00
ti
SUBJ,C®N SFRUCTION AND PL S CECi�
CESS 1�:1Zf+1-P ID FEES oG'.I;(i
TbTAL PERMIT FEES DUE. IotCJW ^S26&05
RECEIPT
DATE
By ✓ '
DATE FINALED
INSPECTOR
M
OPERATION
DATE
INSPECTOR
OPERATION.
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS_
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
_
Gas Test
Appliances
Final��
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
L
Final
Utllity Notice (Perm)
J
Apf,govED. by
iOv - izfx� - S/, ala,
01
magnefic fluid condifioning
t CUSTOM CONCRETE
it COMPLETE REPAIR AND MAINTENANCE
* REMODEL • NEW CONSTRUCTION
SPECIALISTS
TROPIC
SWIMMING POOLS
� SPAS SINCE 1968
LICENSED BUILDERS
P.O. BOX 1772
UC. +312872 INDIO, CA 92202
Larry Morales Tel. 760-347-3218
-_
Ur
m
1
11-T_.
C)
MAP PAGE
LOT
TRACT _
APN
�
POOL, SPECT,FICATIONS�+
SIZE_�XaXSJ SHAPE �2£ETO/Rn.
ADDRESS 'S 9 `1 AVE n,�t4F44W
PERIMETER -I-,?- AREA - 51d
DEPTH.F_X_&!L�VOLUME r
EXCAVATION
ORDINANCE GATES TO BE SELF-CLOSING AND SELF -
X STREET .Oli F /l1 A d1R1(J
RAMP iyoifif GRADING: ✓ STUMPS&AQ g
HOME PH 7 7 'YQ BUS. PH
'!
SWIMOUT FENCE
PLANS BY CHK. BY LM
SP L� CONCRETE- i itv RAISED B.Br-,0-
DESIGNER
MISC.
STEEL
CUDTV
SWIMOUT — LOVESEAT = RAMP—
SURCHARGE POOL LIGHT
RAISED BOND BEAM SPA ,
MISC.
PLUMBING
SUCT.J Z• RETIL PUMP IkAo
SOLAR A1-2
SOLAR SWP.
HTRekIL_ FILTER H M ad) FILL LINE
Uj
.d ..,�
"�+. sfg
Z ;,,,
>
SPAe2'd SPA LIGHT RET JETS
BONDING
PATIOS DIV. 8D.—
SLIDE OTHER �!Tcf L-
GUN ITE �.
RAMP '— NOTCH 8.8 LOVESEAT
,,,,,�
RAISED BOND BEAM — P.S. STUB
SWIMOUT � SPA_:r ANCH
MISC.
TILE & COPING
TILE PnUo_l� srd& T&bPINGd�,64
TILE TRIM SPA WALL WIDTH
;� SPAS RAISED B.B.
�- i I �i MISC.
BUILDING & ��b ! � Y E ARTM0"F IA
� ; PLASTER
it n. n I COLOR/e (e_1 IL- SPA
_ LY
DECKING
CCEPTED t R oma)NS' 6 c�L+t,.�-':.,0.1 1O'N R BYjw.s.�,e TYPE ,llb SO FT
•- F EJE TO :int 1d�m_.' gg- N ' `' '0 P R' I FINISH
AND ALL AP11CABLE• CODES
�5_&16
c9FrtG�
A CUSTOM POOL DESIGNED
ESPECIALLY FOR:
ELECT eY-"P
SPC. INET.
GAS BY
SPC. I NST.
ADDITIONAL NOTES:
NAME Z/ fes a&/ t- J C / / &--
ADDRESS 'S 9 `1 AVE n,�t4F44W
OWNER:
POOL AREA TO BE FENCED. PER COUNTY OR CITY
CITY 1A (O U / A/ rA 'ca
ORDINANCE GATES TO BE SELF-CLOSING AND SELF -
X STREET .Oli F /l1 A d1R1(J
LATCHING.
HOME PH 7 7 'YQ BUS. PH
'!
WET DOWN CONCRETE SMELL AT LEAST TWICE
PLANS BY CHK. BY LM
DAILY FOR 7 DAYS.
DESIGNER
DO NOT TURN ON. POOL LIGHT WHEN POOL IS
CUDTV