0201-076 (MISC)79738 Arnold Palmer
LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMITa
U) 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 DATEco / VALUATION LOT Cr7tlI-{)7!S TRACT
fV LLj Professionals Code,and my License is in full force and effect. , •.
C 5 ch License# Lic.Class Exp.Date I
(y JOB SITE ^ ^ APN
LLJ ADDRESS '(/ - ( J(
0' Z r` Date 1 i .—Signature of Contractor Z ! OWNER CONTRACTOR/DESIGNER/EN (NEER
O 'r
J U (D OWNER-BUILDER DECLARATION VJ.iiL'i'R1+: 1'1)113'.}'I tif }):T).,M+1R k?/jCI}( 11't1F111ti./1),r:i:i.A1'I'RJ;C77CW
H UJ
I hereby affirm under penalty of perjury that I am exempt from the Contractor's !'i?t.'.+} +, y(160 S.13'V,* }_f'():f''ONC}'1.1 11G]TW rtiy u 1) :1 i(?
a. ..
N License Law for the following reason: t r Q0.)[AIT.AC°AkL"
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 (I(,p) CA S7;on 51323
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section B&P.C.for this reason ttllJlaT]tJ;;f JU• t ;= g?, 'x•751, ??r•iAC, Y •: r7, 'V'QLaITI P,1LY
O N Date Signature of Owner .t!'}>.r.►i'`f?)IIM 11,4000WIC.A'rfON8
a- 0) _
Z WORKER'S COMPENSATION DECLARATION
io Q cr I hereby affirm under penalty of perjury one of the following declarations:
LO i— O ( ) I have and will maintain a certificate of consent to self-insure for workers' A1,t1/1'1 Al.1
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q V) 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
tl: rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
Cb v +'rf,'J'a:r )ND P-160111N)TO009,1?S E,SD.RSA' : .x)C".(+S.rr):I!'{:4).N81701{'f#uN
g (This section need not be completed if the permit valuation is for$100.00 or less). VF.$k.1'V}'t.l FCC,UtSMM IkR.1f
( ) I certify that in the performance of the work for which this permit is issued, }iEE 10)-000-4)8•000 $20100
shall not employ any person in any manner so as to become subject to the ;'i';c1?1i,i MCIJ'K,-1N F'K • Z;FS1t) '101-0004441-O00 $'TOO
workers' compensation laws of California, and agree that if I should become
3 subject to the workers'compensation provisions of Section 3700 of the Labor
Code,I shall forthwith comply with those,provisions. i
Date: ' 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. t
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 ti;T.f -1'l,.,'j`)1,1:,t.9onk f j.?1:;1('!'f jom li? !.}71'•:Q'z6iti $70"i 00
any permit issued as a result of this applicaton agrees to, &shall, Indemnify
& hold harmless the City of La Ouinta, 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 WI'AI,ir'YRMIlJ!<":P'!;ES.ili:)F. ;C1W
permit, or cessation of work for 180 days will subject permit to cancellation. IIIIIIIIIIIIIIIIIIIIIIIII
I certify that I have read this application and state that the above information Is 01
• correct. I agree to comply with all City,and State laws relating to the building IE
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes./':
RECEIPT DAT5 6Y._ DATE FI ALED INSP CT
Signature (Owner/Agent) ` ` ! Date I 1 / ` r 3 a
, Z
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
t
Final
Final
BLOCKWALL APPROVALA Steel POOLS - SPAS
Set Backs Electric Bond
Footings Main Drain
Bond Beam + Approval to Cover
Equiornert Location
+ Underground Electric
Underground Plbg.Test
Final Gas Piping
PLUMBING ;APPROVALS Gas Test
Electric Final
Waste lines Neater Final
:'Vator Piping dumbing Final
Plumbing Top Out Equiomen'.Enclosure
Shower Pans 0.;:..or Finish Plaster
Sewer Lateral ! Fcol Cover
Sewer Connection _ir- Encapsulation
Gas Piping
Gas Test
Appliances —"
F;nat
COMME TS:
' Final
Utility Notice(Gas)
ELECTRICAL APPROVALS
Temp.Power Pole
a Underground Conduit
Rough Wiring
Low'Voltage Wiring
Fixtures
Main Service
� 5ub Panels /
Exterior Receptacles
G.F.I.
Smoke Detectors
i Temp.Use of Power
I
Final
I Utility Notice(Perm)
t _ 11111111 IIIII III IIIII ILII 02
'E GENERAL SPECIFICJANS?
Ilk
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SIZE-90 .33 AREA ,foo DEVr
��y -- - ' _— CITY
SHAPE f Z/S7_0 ma'► P
y _ = i.- i'� ��`�jy, • TEMPLATE 0 .CTILE SIZETLLE COLORcovlNc
- v ..._.-`_._.._._ / .-- cS 6t7':.:5s� a:F.... •a : -. l; .� , �'-'nw/ItTv r, I� - _- COPINGR
_ GALS
.� _ _ _ _ __ _ W- 8 - _ PUMP CAPACITY �D� G P M
- .— ___.•._ �� ..... MOTOR H P s N P
'/'� // /v��7_ES °� FILTERI_ '-- __--. _ __. .--.._. '�/ _ .__-..__ _ _ -r�- ._-__ _ AUV_ p�e l/' - - I, , �r �.y FILTER RATE
SQ
OpR
I> y00 TURNOVER _ G M
C tn` _.-._--- /---_-____ _._... , -_. --_ �_.__..-.�___' •.--"/._ �- "I - _ -.�_ -���. ......._.- -'--______ .p�i/ A(I' Y•/�•••//TS'�_ •_ VACUUM LINE i SKIMMER � MRS
a ` _...._.. ._....-__ -_- .___•_ -- _ _ -�-�-_ _ _ _� - _ _ _--_ _ __�...._ �L/QLJ �'I S�'/Clit - RETURN LINE •i
I? __�___ _. _ i` . •__ _ _ _ ---- _ . —__�� ?"'x/ P //sof "s
T __.—.__ ----- ._ --- .-• ---�. ..__.�. ._----- -- -----• - --- ---- _ - �. - Y - - _�----- - - -- Al :7i/E DA.w/i/rIII MAIN GRAIN
ISA - -- -._ __.._-_ _ •-..� ____._.__-.-.__ _. ' _ -. _ SKIMMER-MODEL
_.__. ._- __--.__ .___._. _._ ___w___._ --._..._ _ _.__ -�__._._.__y._• . _ Y _ _ _ - _ _ - .� - - BACKWASH TO
FILL LINE
ANTI-SYPHON VALVE
-- ------ _.--c---..- -_ ..__-...__•-__._'_._�-��__.-__ _-... _- _ _;- ..-..-.._-_ _ _.^_.�._„-__'--'- _ '- NEATER LAA SIZE Cf O G BTU
fS
-- '_ _- - --�_�`-_w, - _�-._ r-- ----_ ---•------ -«f' 3 - _ _ _ cASUNEBr VENTED BY
LIGHT
._.-»-._-y- - _ . _ ��/ - - - -- _ r,. - S' �.. CLOCK O (I
G r __ ! -
_ ____. ,_� -_ _ _ _ --- -t- _ - ---- _ • �,� ELECTRIC BY
-
.. ELECTRICAL BON PING BY
0�
y.
' POOL CLEANER
- _ _. ._ -_�_ ._.. _ - .- -`_ _ --•_ _.- _•._._. _-: _�•. ._-:._= /wR�//MDSE __ _ __ _.__ . .� ._ _ ___- CHLORINATOR
-- - -- - - - - - ---- - --_ ilUR/CIE BOARD-SIZE
-- •------^----- -- -- --._ _.------ _.--- -.. ,__-....-- - :GO�NS� .. - ... .. _ ._ ..-..---''- ^_-- -- ------ BOARDSUPPORTS. Tile:
-,_,_..._•`-"�- ----_ .. _....._ ._-___.__� - - _. __-._...-_,...._. - ...__ - ._.- .»----•,.- LADDER-Model -•- - -Tile: -
-
SLI
cw, SA. w...,
.. _ .._
..
1, ROPE RINGS w/ROPE L FLOATS
` a I GRADING DIRT WALK
STUB PLUMB Q pe NO TRACTOR SIZE-
TILE A COPING Q Aur Q 01N
_ �. -- -- -_ - - - _.. - --.-• _ \- •_ •__ .-�I __.._: -. _ = _ _. = _ _ i ___ DECK Br: D -
_ TREES. ETC.
(V •;) ew�� �.r���l��y�•>!� i1 - ` __ _. I'� • _... _ ! CONCRETE REMOVAL BY:
• • ' \ \ eA".O;ONO I A"
/ �..{ IL; NO Q N[IOMT w10TN
c�QO AM[ .,t/lX AiVyoN ,�'�ONES
6 Ste'
ADDRESS . 79'738' opfVelq P",g-/P
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\ ^ - 1 ll ! / l -- _ �• 'y/ _ - - I _ _ \ CROSS STREET{ ��.� 1
M.PHONE M.PHONIE-
Steve cAclion (�on9frucfion inc.
77
N 68-703 Perez Road Suite- A-25
Cathedral City, CA 922334 .
Lic. #455607,
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