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0307-024 (RPL) LICENSED CONTRACTOR DECLARATION PERMIT# U) I hereby affirm under penalty of perjury that I am licensed under provisions of ryvMDING PERMIT H Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION LOT. TRACT N W Professionals Code,and my License is in full force and effect. �tj ' O =) M License# Lic.Class Exp.Date f '' Y � �J:?=J AIV en;'��::c-P. ��i�IJ�i� ADDRESS 45x TX:L�.� AjY.i�.�1013 SITE �E APN LLJ f` / � r Z Date a� I �`��' Signature of Contractor— 6 OWNER CONTRACTOR/DESIGNER/ENGINEER r0 O' Y•�� a ::71.:'.Z 1AJ4.,%.rt.�.t'� 711 s.MRAZt.ER. CAU 170404!1 t F''b��+-fLS&8PP1% TV'A` N�,W'!!<X�� , H OWNER-BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's 1L iy P' ; r3 . . 4 CA S121,w?F, I— a „. ,�4,13;3�'i'i.-!. �'.,t•. �`2�.�,� a,.,4"r.Ati...�:���:ia.: N License Law for the following reason: ('�♦~:4^i ;� w w ? :rib �JO:}}> 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)' USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed b0011NNDANR SPA contractors to construct the project (Sec. 7044, Business & Professionals Code). r n&,W.Mlg r`ltaPY' .fioe� :.t: c () I am exempt under Section B&P.C.for this reason FQU1ilAM01T F_€(:10a+VRZ'RC?`!.'LO N Date Signature of Owner ON rn a Z WORKER'S COMPENSATION DECLARATION C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations: POn-L,, NDIOR WP.� U-) O ( ) 1 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 mJ Q performance of the work for which this permit is issued. Q U `{,)__have and will maintain workers'compensation insurance,as required by O U QSection 3700 of the Labor Code, for the performance of the work for which this Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are: `r Z Carrier .:7A'?'Ya+;'0MPLN0A.1Y Policy No. 046-6163-200.1 FSI:I11YAS)"D Cogr UP CGRIXf RIM.V.r-ONC) R11"YER W"MAWRY Q (This section need not be completed if the permit valuation is for$100.00 or less). PUN EHEC FEE -WO-43'9-31 176.05 J ( ) I certify that in the performance of the work for which this permit is issued, CPfiS f3i.�C'I tK3tI rt"� .,1-{3C!() 1 4-t?t r;i $11.7.0 I shall not employ any person in any manner so as to become subject to the MECHANICAL FEE_Kl,:tl 1. i 11-On().4*11 workers' compensation laws of California, and agree that if I should become Elm.XYt;1CALter! )%001, ;f,,;a •dfif}•� � subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those�provisioy4s''a Date: '�,.���� rs Applicant ;a; = p� Warning: Failure to secure Workers' Compensation coverage is unlawfu � shall subject an employer to criminal penalties and civil fines up to$100,0 addition to the cost of compensation,damages as provided for in Section $ 2003 of the Labor Code,interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and SafO&I'VA for a permit subject to the conditions and restrictions set forth on is Ct�(Y OfC�pEPT• application. FSA` 1.Each person upon whose behalf this application is made&each person] -`[ T ah j'S:T.is3 t13 t i 'LAS cj,PVCK:; $:'s.99.05 whose request and for whose benefit work is performed under or pursuant to- ;bw L' :.}raj 3 fT•;?(;�s $10,00 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 'SMI..,k f. �►! f '?i�"... ?1r3�•�4' ' � .+.cam."� 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 21 _ , correct. I agree to comply with all City, and State laws relating to the building 11111111 IN construction, and hereby authorize representatives of this City to enter upon IE the above-mentioned property for�inspection purposes? - — - - - j G RECEIPT DATE BY DATE FINALED INSPECT Signature (Owner/Agent) f�'� ,>�r ��" �Y`" Date l6 "� - sr 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 POOLS - SPAS BLOCKWALL APPROVALS Steel —� Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover X 7 h Equipment Location Underground Electric Underground Pibg.Test Final Gas Piping PLUMBING APPROVALS Gas Test '3 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 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 Final Utility Notice(Perm) SPECIFICATIONS TYPE SIZE WRFACE AREA OF POO PERIMETER DEPTHS Imo• MAX. x SPA EyCIFIIPA?ION5 (j/ TILE ^ Silk X Y _( SPA DAM 'WALL YR?TH WATER LINE _.#`�'. N0, OF JETS TILE TRIM WARTS ROUND d LIGHT RASED SPA AT SPILLWAY TY PEt } > 4: r # s.� 'fCIAL NOTES �—DCC—KING .__. _ _�_ u7 ( L L 0 z e7 XCAVATIOt j STEEL _.,_...__ 7, FINISH .. ai DIPANS10k JOINTS ----- r y - . DECK DRAINS `1'k'�P'END RAMP —~—_.-'__' y'- q DECCO DRAIN — ! lOM6 SEAT "'.'..P..... ...� CONCRETE REMOVAL __ LOADS I CURS CORE SOD REMOVAL " " LOADS STEPS -w STEP FACE TREE REMOVAL BY IRRtGATHNt REMOVAL TILE BASE '! IRIBGATION REPAIR SAND AND VlSgdEEN ` l M 8'R.BiRl. MOW S �T i 30' RS.9, � { � TAN S W DEPTH } -�--- -- MASONRY RM rlK F C80E RC$B fAG#VG A SPIIANAY TYPE «..�^-------- s4ZE G PLUMBING sm's ..,,, i PROP, EXT. WALLS i FXTER S ZE „h E �) _.�c" r" p PLANTER WAtI f` i'001 Ptd t { SIZE Rif TAid` 10 WALLS 8at#StER'PtN StIE Eou . wALLS A4D L PtgW SIZE I _w AWL PUMP40 boo,P—rq Ai,� -- --- I Tw HATER i -, r ou _ SWAP TYPE FILL L `a f E�8 AS R GAS LINE 3 ` .. 5P4RlS u0m R?( ..:a � - . T ��' •�':. t.ltpil5 SPA FfJEMt AME5 e ALLs __ RtaIL:ED BEAtR i 15 SPICER DESaEyT�. BETS SPA • �.' ;...-� • � � y '.„ ��: UMM IN POOL IN SPA # �� < s k w a , _ ING Aft, ENG �. �' MIX FENCE "PPE } PLLNiRR!!NC t �c k.: v SIZE HEIGHT GUNITE � GATE REVERSAL . i© DEEP END RAMP � REMOVE er R�rANc I •o < EXPENDED 27�d STEP -^--,�---- -----..•-._._.._ �_...s_. r� LOW-SEAT SPILLWAY TYPF ETAJRT roti. w *• EBT. /61% CANTILEVE? w t t +,++per�✓^' ,}ry.' ! I ,t y},� F{.3.13. Sf" :� eE3. J _. ;r t r f { • t rr: , x s :;( OWNER T ; (1) DETERMINE THE APPROk1MATE ELEVATION OF POOL 1A SFA A: ..AYOlLiT ,:ti D ` Jp EXCAVATION _ , { `is Q ,} .T 'r A s}"T• (j O I ..»,..�..-.,.�F ,- � (2) TAKE Na?TGf THAT PQ(X, AND EpkIIPWENT LOCATION-9 dr�E $UBJEC {C C, •,��.. : L(%GAI.�,NV' DEPJtRTNST' AT {�'3'�iS!,IANGE � P£RSfCT 3, :.QRi AT DAI. F[,?}T GA �. _ #5 i#�STA� hET DOWN CRETE&HELI. LEAS'Y TWtC SEVEN nom'L P ;. ,.. ,.,, 4 THAT ORNtA i T Rf SVELE FOR TSYtOw'�.` NOIT OF3JEC. ,... ,:. .__>.s v ... , _ ., .� «. AGREE „ALk' P€xX.� S N0 SPON L?tiOER 5.7R �. ,,.. , i ,�, s ,•. , . ANY A TO & DRtVEYYA'tS LAWNS ft£t T? CEIAS �4 Tldf AtS_ .+tzifA � �� AND DAMAGE CURBS,SM"S, . s.'3Nf __. il +L f i 7 r F' 5 INA. ALL Ff1Nt GATE Ati7 �ARAwE DQ(9R5 WEE'LOCAL Gx t C�-� #,r� SEE t�. (.; z r, ,� s y•., s yy.r,-h , ,. ;. r !4,.. �i PfiYfR T{3 Pf�lAS� EC110N ., ...x t.,':- 'S.✓.1:' * n - ,xo, .* ., „ �..Y-.• _ .- - ' ;. .:r s; r i. _ Y (FOLLOW�V Tf!'LtC110N5 -- ?'J 'SOT 135E Rx�i ! z� 4- ..„._.� .---, ..,.�,� „..,,•,w.,.�._ ,� .« � x (RYA FILL P091. IMM1fDIATEL A#�'T'ER PtABT£R +< S �'cR v .. i:. t 7 TA}� NOTICE THAT THIS pltlltMAIG 1S TH,S Sat..PRt1PERT7 OF irk,.tfOR!rt�, P(I<7LS AND `!flAP :dlE:'' .. {. .„ ;,,., .. ,. ._ ,• . , .fSf W{THOUT WR.T'TEN OF CALIFORNIAPOOLS, INC, #�TED R u4 ..._..__. __. <.w+'>• _.,.....vaT:....y +ice t#.. _:. g w .x. a.. e.:.. .. ..., .,„, ,>,---. r' ,. .� ; �:•- , .. �, ter- f T €; .., ' � OMR!dER APPROVES P+.A#a AND E>�#tT LOCATIONS AND HAS READ �: RE i1TT£S APA3 tiOTTCES A00VE. ' ..,r_..,...a_.__:., C d a :;m. fir•, w' ...,.. , - sxNATu�E($? SIMM# # , PQM PLAN FOR: i .SAP ..— :c T . , NAME '" �'mtSID""' • STREET, - 2, 3 m t�{-,� JOS ADDRESS r; ,JCS '4 !' '" " : CITY �" PHONE C FFICE RES «(}? TRACE' PAGE _. MAP BOCJI PAGE NO. CITY --- MAIL ADDRESS ( TRUC, ON OFFICE PHONE NO. �_��-��-)' 1 SCALA QATE DRAWN BY T + CNr C e aOB uj a v • x - ' ,. i� 4TRUCTION M. ticc ION h DIG 8OUL.DE'RS �aO{ gyp P� E—G N1 l- f 0 -1 ti u. p JANDY �J;�rl)F t2C:KOtitiU P em./PLA,S ()f;CK SIGNATURE PRG-1'C I I..I DRAINAGE 4iNAGE NC E: Drainage and irrigation for plonters and Pets, by athor.s unless otherwise noted, E I AI.,