RPL (001371)52215 Avenida Madero
001371
LICENSED CONTRACTORS DECLARATI
(commencing with Section 7000) of Divi
and effect.
License Class Lic. Numbbwer 11IF, 41 -
Date, Contractor x 1 ""' C
OWNEWBUILDER DECLARATION` I hereby affirm that 1 am exempt from the Contractor's License Law for the
.following reason (Sec. 7031.5. Business and Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for
such permit to file a signed statement that he is licensed pursuant to the provisions of theContractor.'slicense Law
(Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code)or that heis exempt
,therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars (S50O.):
0 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 and Professions Code: The Contractor's License
Law does not apply to an owner of property who builds, or improves thereon, add who does such work himself or
through his own employees, provided that such improvements are not intended or offered fonsale. If, however, the•
building or improvemnt is sold within one year of completion, the owneL:builder will have the burden of proving that
he did not build or improve for the purpose of sale.).
-0 1, as owner of the property,,am exculsively contracting with licensed contractors to construct the project (Sec. -
7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the
Contractor's License -Law.).
-0 1 am exempt under Sec. B. 8 P.C. (Attached Certificate):
Date Owner .r
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure, or a'
'certificate of Workers' Compensation Insurance .'or a certified copy thereof (Sec. 3800. Lab: C.). .
Policy No. Company
0 Certified copy is hereby furnished.
0 Certified copy is filed with the City Building Inspection Department or City Department.
Date Applicant
PERMIT APPLICATIONS f "
City of La Ouinta
Department of Building and Safety
This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days.
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if
ON:
'I hereby affirm that I am licensed under provisions of.Chapter 9 " the permit -is for one hundred.($100) o, less. I certify that in the performance of the work for which this permit is
sion 3 of the Business and Professions Code. and my license is in full force • issued. I shall,not employ any person in any manner so asto become subject to the Workers'Compensation Laws of,
California.
APPLICANT NAME (L, F; MI) swqn Fools -
ADDRESS ' 67-652 Ramon Road
CITY/COMMUNITY/STATE/ZIPPa]ms CA 92262
922
c -, _ a. , ,F
JOB SITE ADDRESS/SPACE 52-215 Avenida Madero
CITY/COMMUNITY/STATE/ZI La ta': CA 92253
BOK -
PAG
PRC
C
Mech. Fee
TWIN
RNG SE
1 I
S
?%
TRACT
LOT
Elect. Fee
_
MOD
SB
C { f, i1
TRACT NAME
OWNER NAME (L, F. MI)DougD } • • ,
L ' [
CONTRACTOR•FIRM NAME
applicant
ADDRESS
abovle
CITY/COMMUNITY/STATE/ZIP
above
PHONE 0
320-'6996
' LICNC
ARC/ENG FIRM NAME
ADDRESS '
CITY/COMMUNITY/STATE/ZIP
PHONE 0
LICNC 7
"
USE OF PERMIT
Pool and spa
BL"
ZON
FSB
SSB
SSB
RSB
OFC
'
ZONE ORD
LOT SZ
END.
SIDE
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forthwith comply with such provisions or.this permit shall
be deemed revoked.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
01 hereby certify that no excavation five (5)ormore feet indepthinto which aperson isrequired todescend, will be -
made in connection with work aGthorized by this permit, and that no building structure, scaffolding, falsework, or
demolition or Cismantling thereof, will be more than tKirty-six (38) feet high: (Chap 3.2, Grp 2, Art 2, Sec341, Title B.
C.A.C.)
0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of
Industrial Safety, as noted above, unless such person has a permit to do such work from that division.
r.
,0 Division of Industrial Safety Permit No.
Date Applicant
CONSTRUCTION LENDING -AGENCY: I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Sec.'3097, Civ. C.). -
Lender's Name
Lender's Address
I certify that I have read this application and state that.the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the aboGe=mentioned property for inspection purposes.
Signature of Applicant or Agent Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read thisapplication and state that
the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling
construction, and authorize a'representative of the City La Duinta Department of Building and Safety to enter
upon the property for which I have applied for this permit for the purpose of making inspections.
I
A fore of AApplicant/urAgenf Date 1
Print Applicant/Agent Name /l
APPUPRMT ,fl n l .171
IHS POOL
Pernut to build pool and spa as per
app plans.
Mech. Fee
17.50
Plan Check Fee
60.12
• C'onst. Fee
92.50
Elect. Fee
12.00
aff Fee
•O
Phubing
18.00
TOTAL
FEE
200.92
A09%9- • 5
BLDG.DEPT.
9 -- .
VALUATION 12,000.00
NO.
OPERATION DATE INSPECTOR
NO.
OPERATION DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs & Frms
34
Plenums & Ducts
2A
Slab Grade
35
Furnace Compart.
3
Steel
S S _
36
Inlets & Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P.L.
❑
43
Final
10A
Fireplace T.O.
❑
OP N
NO.
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25 Final
Tank Pit L. Line
ELECTRIC APPROVALS
REAR OF PROPERTY LINE
P/L P/1
STREET NAME
26 Power Pole
27 Conduit
28. • Service Entrance
29 Wiring
29A Grounding Wire®s 11/
29B Bonding S
30 Fixtures
31 Service
32 Final
1
4-6
V- -.i- `•1 u -I Al.
OYER/OWNER/S AD'DRIESS CI1Y ffr'i. jCONTRA 7, DATE r
lS w Y t
vY ins{ +. ,;• . •,. ? t ;r 5 gwsv t ,k't3,r
x... _-' __-._..__.. _....... _.._.. ._
--- ------_.... __._...-'--- - -- -- ----- --- J{iti fyfaONE.. ,k„ .41
MAP
'r
MAP BOOK PAGE LEGAL DE"r RIPTION _ l.01-TRAl;t'
?Owner and Contractor acknowledge that FAL Vii''! < U'I"f-i(Jr I yXrioi\j
they are responsible for the following:
Contractor/owner t Fence Removal by
' Fonce Replacement by
Tree Removal by - - - - - - - - - - - - - - - - - - I - s 44 it
,r
y Tree Hauling by - - - - - - - - - - -
---- I
'Decking by ✓ -_ - - - - -
iExpansion Joints by ✓_ _ _ - t-
`TRetainin Walls b - 4
y ' Soil' Re orfs b -- - - - - I - r r.
Deck Drains b -- --
Fencing by -
Gates by •
s 1' SALESMAN MUST INDICATE LOCA - - - -
TION -ON THIS SCALE DRAWING OF .
`ALL•'ITEMS LISTED BELOW AND THE
t
FOLLOWING MUST BE'• ACKNOW - -
.LEDGED BY OWNER. IF THERE ARE - - - - -- --_ - _- --_ - - - -Ir - f <
ANY CHANGES.FROM LOCATIONS ON - - - - - - - - - - -
THIS DRAWING THERE WILL BE AD -
`:DITIONAL,CHAPGES. - - - - -L... - - - - - - - - - - - - ? - 11
r r, 111
r"Sha a of Pool y '
K r, • r K
idt . Minimum
Lan th:=Maximum,- - --- -- --- - - - -- -- - -- -- --- - - - 7 r.
en th inimum - - - - - - -- - - - - - --
g I - r - I' a A
fi a#.Depth Maximum - - - - - - - - - - - - - - - - - - - - - - - - 5
Det Minimum
R
i iter ••ocation
-
n win Boar Location'-
:: i 11 a ocation
ts; eater Location - j - - - - - - - -L.. - - - - - - - - - - - - I r
ec ing ocation - - - - - - - - - - j f
Ly imrtier Location -
rep Location 'C:) • ' ' ' % • 3 _ ^'
£* hapeo reps' --- -- -I' - - - - - yD - -- -- - - -, - - _--- -- - --- -
Access Dimensions -- o
'•;Taps Toes o Slopes "' f `'
it '' C7 - -- -- ------ ----- --- -- --- -- -- - • - '`
lFet
aining Walls
3 Truck Load Point.-
Covered
jlettric Box,
---- -- ---- -- Hose Bib
- - - -- - ,.
i J Q Q_ - -- 1 -- 1•.
' }Distance col from o e A _ - - r - - - --- -
„ vHouse &Pro :Lines' t - - ' 11
_ r... E C
Prop: - -
y ver ea Utility ines_ ✓ _
E:r.l ui-J F. 77..
xisting' tructure or a I " ,(_ 1 ti • 1 1 1 -j " '•a
—._ 1 Proposed Struct, on Prop.. '-
ACCESS`¢ DAMAGE OR UNDER
ROUND _ _ -'1 _ ,t V, t
QCONTRACTORp will not assume -- - - - - - _ ,z .x s - r
►esponsfblllty for t}etess damage such as. Q - - - - - - - - - - - - - - - - ; 7, t
t • liamtege ,t0 CUrba;';'sidewalks. driveways, - - - - - -- -- - - - - - - - - - - - - -
eerWont eliba, sewers, lawns, trees, shrubs. _ _
,fenitee 61epAone or other utility lines or
t. rer0Uling`cf;eny overhead or underground 7.;3' .
pr%s Dipes, Conduilii or drainage. Customer - - - - - - - - - - - - - - - - - - -
'werfanis.,,Bll locations on this drawing are - - - - -- - - - - - - - --- - - - - - - -- - - - • ,5
• wlthln.tA01r properly lines... When access is t'
"' medethtough a -neighbor's property, it is - - - - - - - - - - - - - - - - - - - - -- - - - -
underptood chat y0ti, the owner, have. that - - - - "' - - - - - - -
nolghbor's,,permission and assume .lull {
.>9"o.sibillly. NO; soil, rocks, debris. etc.
r - - -
refri0ed or brought in except on Excavation • - I a , 5
ry
640.w.% i is -7-
JH
a
;THli :CONTRACT PRICE IS BASED, f a
y; ONqq,?'THE,: FOLLOWING . MUTUAL' i fry' _ _ _ _ _ _ _ s
' 'AS511MP,TION' OF FACTS: ''
t r; _
,That the alle+has adequate hearing
BDaelly•,Contain0no fill ground, no hard
r rock lormeti_n:or boulders, contains no + ' g-, A v- -
Ce!lpoolil . 6eptlC` tanks, underground - _ sa ! _ « , _ - _ -_:' _ _ -_ _ _ _ _ _ ' R
611(Ity line"" other obstructions, that no
Undeigrt' nd or?,ebrface water conditions .' C" ,• ' r. - - JI
Will'Interf ire wllh`the work of operalion of r t - -
;A th@;completed Slruclure, that no blasting or -
,lack hammer work -is required: that trucks
_ l
,and power equipment must have access to
;the site and that silo access is adequate and
iubstdntial endf•t'.warrant that there is y - --- - -
adequ8le electrical and water supply avail- _ '
:iAble on the propeity for construction pur• - _ _ _ _ _ _ _
poses. Contraclor shall no; he defile for `
W.
flotation of pool After gumtiny Caused by
external water k',! • -
,••° f r}l!,rading m; pool area. only, limited to _ - _ _ I _
CUlYLOf1r 0 be-fesponsible fur ddelrenvima• `
110 •o1 poor elevattiio and ss ed aur., a beyond
r f• ,
pea a acrd . again Cracking, checking; + _at
raising. detlflnp' or' discoloration. Plaster` - - - - _ _. _
rdeeking Wefkb end decking ire noP
1
la.,rtof„ guaranteed; against dis oloral,on, y
s ' stalgtno, checklrip or cracking, Such piastiir
} defeete generally result Irom Local water
ondltlons;;lmproper use bf•chemicals, orL LL
n ck;`.cf .or. Improper cleaning ol, the pool.' _ - - - -'- -- - -
i ny:•walls or grading not specifically on
ty.
ontCr'nttector AIablliIynfor variance in _ _ - - _.. _- - --- -I- - - - - - - - - _ - - _- - - - - i i_ .
7 -
of site shall be.lim,ted to $3 00 a squ, atit ,
'fool., Shou10 aetlons of• customer delay
Constroctiorl,°.any additional costs incurred _ -. _ _ __ _ _ - _ __ - - - - --• •• _. , L:Y a , jK r 1 4 t '• y
bVtontracto/ due to such delays, shall be
r lbwrie by customer;
(s',plan:authorizeIion, in conjunction •,., w
Wine contract; constitutes the entire
.agreement ollhe parties. DEEP
t r d b r l 'a1 )t
'APPRO S AN AND _ - - - - - - - - - - - 8 S I,
• PECIFI IONS:, S ITLINED -_ Efto S .,4.r itr 1 i'
'/ - - - - - - _ - - - -t - y. - - - - - -111 _ ۥ" a H llO 4
R INr° A F1.HA f,E EQ A _ - + , r{ est END `Wrt;r ' t
.. T.. PLA
--s' y , - - - - - - - - -•,-• - -i'- -'I•- - t- '- - W ' 4P, }
1 n IG U.E-fit7xp Nf rrll I
CODE' `
li 5 w'• NEAREST
$; ( IONATURE 1. ❑ NOst eltl ELEV. PT.
t 4
atei iq;Y r PUMP FILTER NEATEII I I f i .ti {ttfra
tl:a
e e Q SxIMMFR LAOUEII lf r QJwan
alesman cAs EkEC. State License No. 421014
5. _," ,.. ••! .!".r ... .r:,.:` METkR ME TEN .t °.., F r-+,t: .