9611-015 (RPL)LICENSED CONTRACTOR 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 # , Lic. Class Exp. Date
Date t/_ ell Mignature of Contractor
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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is:issuea?WViworkers' compensation insurance carrier{&policy no. are:
Cartier Policy No.
(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' compensatlon laws of California, and agree that if I should become
subject to the workers' compensation uovisiozs of Section 3700 of the Labor
Code, Is all forth ith comply with t "o a rova.12 /+
Date: G Applicant-
Warning:
pplicant (/ �� Q•` `
Warning: Failure to secure Worers' 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 at
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
,ff or'nspection.purposes.
Signature (Owner/Agent)Q'� r" Date
v
BUILDING PERMIT PERMT#°NTR°`#
94& 1 Ill -4 0 1 S
DATE i�)G VALUATION x►ai)�I�) LOT TRACT 4285
JOB SITE
ADDRESS 54-7.i6:i'l:i.ViCKA
OWNER
R0.11E,RT K�i.P;i'!"::1i:rA.1:.ikZAR
i4730 P11%09RA
LA Q1J1N` A CA 92253
USE OF PERMIT
P4,AX AND/OR S1'A
POOL ANO SPA 0NL,Y -
APN 760-501-036
CONTRACTOR/DESIGNER/ENGINEER
IT'N't;
68AWA P.i;1* LZ RD. #i-3
fG1 �jib�t-1 3 MA .1043
EX11MATI"JI) C0 y i; Oil tr;O;VVURUCTISION
d 5,t3ii�►.;a+11
P#+at11Ai.T FIEF Ni_iMMARY
—
KANr_HECKt RF,
C0N311` tL1`C1"TK_)N11:
A.fiiCHAN1CAL VE1--1*X)i.
A0i d3i30 �11ti-0Lit1
t0 i-0sj0-1 t 1.000
$fGM.C�C•
S:ri isu
L
VJ-EC .Plt.WAL [ #;13—KKA.
101-000,420-000
$4500
'—
p1'.UmBING lf"Im - f'C3f3i..
10H)W-1119.000
co
I C
S'd fr3-`t'EJI'i At. (_`'(JNKr PW 1 C►N AND PLAN CHECK $363.30
LESS VRE-PAID FF.r-.8 $0.00
RECEIPT DATE BY DATE FINALED JINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final I I
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
14
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
PROPERTY LINE 18" WALL SUPPORTS DECK, FINISH PROPERTY LINE SPA SPECS. GENERAL SPECIFICATIONS
150' FRON1 CURB\ ALL EXTERIOR W/BIEGE ARIZ. FLAG 150' FROM CURB SIZE 6' K 10' 2WPX53SQFT SIZE 16' X 48' AREA 545
_. _ ._ _ _ ._ — ..._ ._. — _. _ ._ — - _ ._ RAISED NOT DEPTH -3' to 6` ---
SETBACK
' .- ._.. .
�� 5' SETBACK LITE 100 WATTS SHAPE CUSTPERIMETER 118
6
5' SETBACK 41 TO WATERS
TO WATERS + 18" TRI LEVEL SEATS YES TILE SIZE GROUP 3
R8, 3 STEPS EDGE FROM P.L. 22" 24" 27" TILE COLOR ALMOND BIEGE
EDGE FROM P. L. ----- +1$'
p -7a -"" -- -` DAMWALL WIDTH 6"N9' RAISE BEAM 41'of+18"FLAG VNR
DOSTING '
~`~ `'Y SPILLWAY SIZE12" X " 78' TRIM TILE STEPS&BENCHES
TREE i $R �� R mermaid .3' POOL CAPACITY 20.520 GALS
::•::;:• 25' OPEN XX CLOSED
-'" 20'-6 " —5' PUMP CAPACITY 60 GPM
36
JETS. #-8 ------
\, 13 9 MOTOR HP STA MAX II HP 1.0
'•' / STA A�IA.X 11 2 HP W/FALL
•� °� "�` ••�"�••WHITE PLASTER }� .•~ r �--. '• BBQ ISLAND:
r e
76"R 'INTERIOR ti +'� /15'6" BIEGEARIZ.FLAG
ADD TWO % g / + TILE IS ALMOND BIEGE TA MAX II 1.5 HP JET BSTR
mem `°a 7' 7,3„ / 20, STONE DECKING TA MAX H 3HP SWAM JETSR
.
AREA °`. � � � 7,6„ � / +a COLOR
DRAINS :sA.;' .6� '� MAX ALL EXTERIOR STUCCO FILTER SYSTEM 3 3.4 SQ FT"
AT BOTH 10'R , ° p/a _ _ MATCH HOUSE COLOR. 2.0 H.P. AIR BLOWER "
SIDES OF } , ^ . ,. ° r 5�� JET �\1� p/a 3 BURNER COOK CENTER FILTER RATE 68 GPM TURNOVER 6HRS
' f _ W S W W/HOOD & ROTISSERIE SKIMMER MODEL DUAL PORT
W;FAL � r�:::.�. CURRENT � R8, � p/a ► U1�TDERCOUNTER FRIG.
� ' � '~ �- --'-' 4 ♦♦ INTO VISIBLE UTILITIES. AIR BAR SPA SEAT&FLOOR
.-- ♦ HEATER LAARS SIZE 400 000. BTU.
0 % ( 3,6 BENCH �♦ S GAI+ EM 79' VIEW FROM GOLF COURSE
,3'R• { 2'8"R 1?6" / CURB 128' IS STUCCO WALL W/TILE GASLINE BY S.D.C. 181'
SLEEVE OVER \ / ♦ 8' DIA. LOU NGE AREA TOP, AND BBQ HOOD. POOL LIGHT (2)300W & (1)100W
THE UNDERGROUND ♦♦ W/ REMOVABLE 54" TABLE SPA LIGHT (1) 10OW
WATERMAIN & WIRES W (ALMOND COLOR) CLOCK 24 HR JANDY A-8
AND 24' UNDERWATER BENCH ADD AREA DRAIN IN PLANTER AT ELECTRIC BY S.D.C. 390'
contrae 73 /a... VV \ BBQ CONNECT TO EXISTING DRAINS ELECTRICAL BONDING BY: S.D.C.
p/a p ` ENTRY STEPS EXISTIN TO STREET. TILE AND COPING S.D.C.
3" DRAINPIE / CONCRETE EXISTING
SLEEVES S S P.L. WALL
UNDER J ANDY A-8 R MOTE BIEGE ARIZ. FLAG
DECK TO CONTROL STATION STONE DECKING,.
PLANTERS (check �;/o�;ner for interior MAINTAIN 'STING � �
or exterior install) DRAIN Ea SLOPE LNiLQ JLU2 ��
D ANG TSO, PLAN=TER
STUCCO WALL A2E�S;'fi�ARF av��
TO HIDE EQUIP. R�,TNSST�REtT.
S TALL X 3' ?VIDE tt! � b`��
DECKING BY S.D.C.
1190 SOFT BIEGE ARIZ.FLAG
44' OF +1811 WALL
1V/BIEGE ARIZ FLAG
L' OF+6" STEPUPS
117SIEGE ARIZ FLAG
REMOVE 1065SQFT
MATCH HOtIS�T
EXISTING PATIOS
STUCCO C R� EXISTING NORTH P.L. 1 DATE GREAT WHITE
400 I �� ALL 6 FT TALL DOUBLE FT. WIDE SHEER DESCENT 11-8-96
BIEGE 1 AIR BL S' "�T ®`` ���� � SFT .. O DISPERSE IVATER INTO WATERFALL
�RIZ.FLAG A ENC �N ®� ��`� ROVIDE MOISI L�'$E. BARRIER ----------
AN
STONE 1 P. All ��o TER T �S�P �S NEW �N BE7WEXIL�USE PLASTIC ; 'i , NVATERFEATURE STONE IS: Name: ROBERT LAZAR
DECKING A OZO TE DEVICE � �cG�� PS��G� VIS SHEETING :.:::' :�,: iv CIEEGTA BIOZ. FLAG SHEARS Address: 54730 RIVERIA
F �� �.�G E �?J/STE.EL STRUCTURE !_::::: ELDERS
SWI? T CURRENT USE= �QQ .( TALL IS BASE FOR WATER
" City: LA QUINTA, CA.
--------- (1) 3H. . W/3" SUCTION
/ ::::"'`::::::::` "PGAW"
�,' FEATURE, MUST STAND ALONE. : �': VATERLEVEL)
(4) HaI WARD STA D 7IALTETS NO PRESSURE ALLOWED ON
Do sow
EXISTNG WALL OR FOOTING. � �. 12" BOX TYPE BOND BEAM
\ USE1/2" REBAR
% ' 4 EXISTING GRADE
®L Poo/af
BOBCAT CI j- j� SHOW ROOM
REA10�'E ENING WATERFEATURE IS; 5 FT,}fALL X 8 FT WIDE (AT BASE) X 5' NIDE (AT TOP)
EXISTING � STEEL GATE FOR 73011 COUNTRY CLUB DR.#F-4,
CONCRETE ' ACCESS 01ZY PALM DESERT, CA. 92260
REPAIR ALL LANDSCAPEWATIERF'ATURE3 C ROSSECTR®N WAW PHONE (619) 346-4032
TO ORIGINAL LIC # A-574127 ,jef `'lam.b