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RPL (0403-143)54245 Avenida Madero 0403-143 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 ' 779165 AD ; AD,n , 5131/04• Signature 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 Cod for the performance of the work for which this permit is issued. My workers'. compensation insurance carrier & policy no. are: Carrier v Policy No. b`%J TE MND} 1.6ON67-.2010 (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, an'd agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code; 1 shall forthwith comply with those p ©vi"sions. ' Date: IK Applicant y ' , 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. 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 for inspection purposes. 4 / Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT o4o3--f43 TRACT JOB SITE ✓ j a - APN ADDRESS OWNER CONTRACTORS/DESIGNER/ENGINEER Mcx 1ADD70LF1 CMY. OFA' VIEW POOL L b 34.24.9 AV'RNTIDAM ADIIA0 RD LA QtJ.11 TA CA 92233 PALM UP:f7.iNGS C -A 92262 r -'76g7713.2700 OB1,0 2951 USE OF PERMIT POOL, SPA, a LAY, 6' BLOCK WALI^ Cl TY STA130ARD ADDITION, Of' 1408 BIB% OVI Ofi1'I, T PER PIAN, L ';t i01 R fig, 3#iA1,L BE 114 PL&CG AT PRE -PLASTER 1143PECT1014. 3 Ff. WALL POOL A.WLVOR,, SRA a, Do !1? 1:,E1 .60 LS D COST OF ;f)^IS '.i ' !C' ' " N 14,1i1M.29 l C° 9 yE' tS lS' If . :`,i yy ^g y VER PkVssA,U Ai'ER C1yC:AVJ.Nad .11G;S PLM CREC K FEE' 101.000.439.318 CONwfi'lt ICITfU%i FE -11 301-000418.000 $162.00 PAEG'hANIACAJ, FEE -- POOL 101-000-421-0110 $24,00 ELECTRICAL FEE- POOL 303-000-x4,20-000 $115:13 FLUMtBil+fQ FEL+ -- POOL 101.000-419.000 $33-00 f/J Mn 3 ;— 2AA. : ' ' ..Q 'fM 101.4 AND S`1'..W 01MCK x;3,70.05 CITY OF ` LLPRE PAD ; T.I `..' T 0100 FINANCE p;VfT. ' PT O AL .PF 1v1 E': R. DUE NOW $370,05 RECEIPT DATE l f BY DATE FINALED INSPECTOR 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 BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam 6 7061 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 Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low VoNage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Adinolfi Residence 54245 Avenida Madero La Quinta, CA 92253 GENERAL SPECIFICATIONS DIMENSIONS: POOL SPA Length: 26 feet N/A Width: 12.5 feet N/A Surface Area: 220 sq ft N/A Perimeter: 67 ft N/A Depth: 4-6 feet N/A Demo: Purification System: Concrete: 25 ft in lower driveway for run to pool equipment Sod / Gravel: N/A Plumbing: Fencing: Extra Spa to Equipment: N/A Raised Spa Bypass w/ck value: N/A Dedicated Vac Line: Yes Gas Line Extra: N/A Gas Line for BBQ/Fire Pit: N/A Spa Jets: N/A Decking: Color w/salt finish: 400 sq ft salt finish, color to be selected Cantilever Edge: 67 feet 3" Deck Drains (per LF): 90 feet Step Riser (per LF): N/A Dam Wall: N/A Raised Bond Beam:. N/A Umbrella Sleeve: N/A Tile/Stone: Basic Tile Group: 67 feet from group 1 and 2 Quartzite 6" Waterline: N/A Step Trim: N/A Tile Raised Areas: N/A Masonry: Spillway: N/A Waterfall: N/A BBQ: N/A Firepit w/gas line: N/A Boulders: N/A Equipment Wall: N/A Paint/Stucco/Plaster: 200 sq ft Pool Finish: White Pool Plaster: Yes—Light Grey Pebble Pool: N/A Equipment: 3/19/04 Matching _ine Scale in Feet 0 1 23 4 5 6 Cement Basin to be installed later Run10 VAC w/ W.T. J -Box and GFI outle , and hose bib for later installation of fo ntain by others. Pump: Hayward 1.5 HP Filter: Hayward 300 Heater: Hayward 250k BTU Controller: N/A Hayward Navigator: N/A Pool Light: 400 Watt Spa Light: N/A Purification System: N/A Landscape: 500 sq ft Apache brown gravel w/cloth weed screen Patio Cover: N/A Fencing: Demo 10 ft front wall for bobcat access, and repair to match existing. MISC. SPECIFICATIONS: Two 110v GFI in WT Box and hose bibs per plan Buyer is aware that oral representation or expression by either party is not binding unless detailed and signed by buyer and seller. gravel 22'0 ;'gravel Rase wall to obtain 5' height from grade on street side. Propane tank (Size and location approx. ) I Approx. lengt of wall 20'0 PL Apprc Raise Gate to 4'0 obtain 5' height \ Conc. 23'0 'jravel -.s'o- - ---8'0--- gravel Adinolfi Residence version 9 Existing Wall March 19, 2004 PA Pool: 220sf 67f Deck 400sf Drivewa x. Demo Zone for New Pipe Run IL_3'g - Rase wall to obtain 5' height from grade on street side. 760-778-2700 760-320-3667 FAX Garage Note: Rebar epoxy in place grout cells and re -stucco walls; and fog coat to match existing wall. PA 3 7 ... \ o 6 Feet I., 1T5 V 26'0 3'8- i-12'5 i \\4 Feet 0 3'4 \,\ -9'9--11----- —5'6- 12'2 Scale in Feet 01 2 3 4 5 6 Run 110 VAC w/ W.T. J -Box and GFI outlet, and hose bib for later installation of fountain by others. Mount to wall \ Demo wall and replace. Rase wall to obtain 5' height rav I from grade on street side. 4'6 PA PA ---8'2 — Matching Lin')e CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVE® FOIA CONSTRUCTION, BY 12" Rad. Typ. A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. NO EXCEPTIONS! 3465 La Campana #4 - Palm Springs, CA 92262 - License No. 779165 st Adinolfi Residence 3/19/04 54245_A enida-Madero La Quinta, CA 92253 GENERAL SPECIFICATIONS DIMENSIONS: POOL SPA Length: 26 feet N/A Width: 12.5 feet N/A Surface Area: 220 sq ft N/A Perimeter: 67 ft N/A Depth: 4-6 feet N/A Demo: N/A Concrete: 25 ft in lower driveway for run to pool equipment Sod / Gravel: N/A Plumbing: N/A Extra Spa to Equipment: N/A Raised Spa Bypass w/ck value: N/A Dedicated Vac Line: Yes Gas Line Extra: N/A Gas Line for BBQ/Fire Pit: N/A Spa Jets: N/A Decking: Color w/salt finish: 400 sq ft salt finish, color to be selected Cantilever Edge: 67 feet z 3" Deck Drains (per LF): 90 feet Step Riser (per LF): N/A Dam Wall: N/A Raised Bond Beam: N/A LImbrella Sleeve: N/A Tile/Stone: Basic Tile Group: 67 feet from group 1 and 2 Ouartzite 6" Waterline: N/A Step Trim: N/A Tile Raised Areas: N/A Masonry: Spillway: N/A Waterfall: N/A BBQ: N/A Firepit w/gas line: N/A Boulders: N/A Equipment Wall: N/A Paint/Stucco/Plaster: 200 sq ft Pool Finish: White Pool Plaster: Yes—Light Grey Pebble Pool: N/A Equipment• Matching Line Scale in Feet 8 2 0 1 2 3 4 5 6 gravel 22'0' Cement Basin to be installed later Run10 VAC w/ W.T. J -Box and GFI outle , and hose bib for later installation of fo ntain by others. Pump:. Hayward 1.5 HP Filter: Hayward 300 Heater: Hayward 250k BTU Controller: N/A Hayward Navigator: N/A Pool Light: 400 Watt Spa Light: N/A Purification System: N/A Landscape: 500 sq ft Apache brown gravel w/cloth weed screen Patio Cover: N/A Fencing: Demo 10 ft front wall for bobcat access, and repair to match existing. MISC. SPECIFICATIONS: Two 110v GFI in WT Box and hose bibs per plan Buyer is aware that oral representation or expression by either party is not binding unless detailed and signed by buyer and seller. 760-778-2700 gravel 4'0 f Existing Conc. Ili 23'0 gravel — -• 6 0- - 8 0--- – gravel Rase wall to obtain 5' height from grade on street side. Approx. of wall Raise Gate to obtain 5' height S.De Propane tank Existing (Size and location approx.) i i Apprc Drivewa x. Demo Zone for New —7'10 i F - P [Garage Fi • A/C 3'9 Rase wall to obtain 5' height from grade on street side. C/) =D r— Note: -v ' z r m CV I Rebar epq W_))facergto cells and r - two; of ti g coat to ma e s Ing rn v oc;n-t C_') ;V C7 p O m n y M _ t= rT1 CD C7 z -T7 C CD O m o m w c7Zc7(= Adinolfi Residence version 9 Run March 19, 2004 Pool: 220sf 67f Deck 400sf Scale in Feet 0 1 2 3 4 5 6 P\\- 37 VAC w/ W.T. J -Box and GFI nd hose bib for later installation ain by others. Mount to wall 10 6 Fee 3'8 I s 1/34 12'2 T PA 26'0 PA 12'5 0 \4 Feet Bobcat Access Demo wall and replace. + i Rase wall to obtain 5' height __5'6 \ rav I from grade on street side. 4'6 chi O U6) O z go \ 0 D f V C C \ 0 M0 Z °0® - 760-320-3667 FAX 3465 La Campana #4 o Palm Springs, CA 92262 - License No. 779165 to,