9909-0208 (POOL)LICENSED CONTRACTOR DECLARATION
U;w` reby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
U' LO 351673 C-53 _ 01/311201
UJ
oZ r /te- Signature of Contractor
cD O o
J 0ca OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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
N Date Signature of Owner
ON
0)
IL Q WORKER'S COMPENSATION DECLARATION
o< � I hereby affirm under penalty of perjury one of the following. declarations:
LO
F2 O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W �: compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
DO Q U (Y) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier! t�� Policy No.
cb d JI All FUND 4MY-?fw% V1Yti`OE319.33#
J (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
subje t to the workers' compensation provisions of Section 3700 of the Labor
Cd'e, l "s all forthwith comply with,those provisions.
(x5ate: Applicant ►. "� �. „�
Warning: Failure to secure Workers'�Qompensation 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, acid State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
theabove-mentioned property for inspection purposes.
(,Signature (Owner/Agent) 'k ` Date
BUILDING PERMIT PERMIT20
DATE VALUATION LOT LOT TRACT
t
ell y
klllq
JOB Sl I Er
ADDRESS 43-616 ALUA COURT
APN w
OWNER
CONTRACTOR / DESIGNER / ENGINEER
111E 1EXC H NC7E 4390L'P
VACATi N POOLS
7"15 NAPLES 1:R
9522 DON!1LDSON ROAD
LAQU1NA CA '!MK4
LUCERN1? VALLEY CA
y2356
000) 48.6045 CRIA
4335
USE OF PERMIT
K)OL ANC7!t; R SPA
iti:+C,USIIA ONLY, ALAMMa,,RRIU,& SlY l 1. RE IN AT
1NSkECTi(}N
POOL AMYOR SPP. 15,OW.00 L
US i 111,, ATV, f) M. 0Ta 1±.VNSTIZ!.'X7T101114(r..i;;.00
PERNOT FEE SUNIMARN'
PLAN C14ECK FFY. 101 -OW 43.4-318 110 AQ
(Yft%TTRVY-rT0N RT 101-M)_418-900
It.W- 1ANICAL FRE -- POOL IDI -030-121 DOO
UE CTR [CAL ME -- Pi ADJ1. 101-t)(i 420.0",
PLUX1131NG ME — fKXX. f Ol-M-419-WO
NI f13-AYM!, CONZIMRI K"CVON AND T'"!._qN CHT'( F;
-M)
LF:.�.S P1': TAID IThS
til} En
Ttl' Al, PEKN411' I+'1;EN DUE NOW
5363-W
111111111111111111111101
67
IE
RECEIPT DATE BYi DATE FIN LED INSPECTOR
6 e 1
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 I Vents
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Hacks
Footings
Electric Bond
Main Drainf
Bond Beam
Approval to Cover
Equipment Location
Underground Electric/
Underground Pibg. 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
Test
Final •
COMMENTS:
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
1;.�>u�,
;,�U`Irmo�
1 \�
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
Sa
M
l:
VACATION POOLS & SPAS
9522. Donaldson Road
— Lucerne Valley, CA 92356
(760) 248-8045
(760) 248-2919 FAX
i Lic. #C-53=351673
Sales Locations
Bermuda Dunes, Irvine,
California City, Rialto,
Lucerne Valley
1 800 999-1811
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
-PROVED
FOR CONSTRUCTION
SIZE 15'
X 3o'
AREA
PERIMETER
DEPTH 3 '
— .S '.
TILE CHOICE ic- U0 /, . SQ.
DECK BY SQ.
DECK TYPE
COPING
SPA SPECS.
POOL CAPACITY
GALS
PUMP CAPACITY
GPM
MOTOR HP
HP
MOTOR HP
HP
I HEATER SIZE BTU I
' RETURN LINES i
SKIMMER MODEL
—
GASLINE BY FT.
POOL LIGHT CLO,
ELECTRICAL BY FT.
AUTO CLEANER
CHEM. FEEDER
PLASTER COLOR
DECK BY SQ.
DECK TYPE
STEP F t.
SPA SPECS.
SIZE RAISED
LITE WATTS
DUAL LEVEL SEATS
DAMWALL
DAMWALL TOP
SPILLWAY SIZE X
SPILLWAY
CONTRACTOR cannot assume responsibility for DATE
damage to cubs, sidewalks, driveways, cement JETS
slabs, sewers, lawns, trees, fences, retaining walls,
sprinklers, telephone lines or shrubs. Name:
When access is made through a neighbor's property S fj Name:/\j
it is understood that you, the owner, have that Address:
neighbor's permission and assume full responsibility.
City
DATE
SiGNAT URE I RAC I V
WIDE
LOT#J7