RPL (0005-159)44215 Mariposa Ct
0005-159
LICENSED CONTRACTOR DECLARATION
I.hereby affirm under penalty of perjury that I am licensed under provisions of
Chap er 9 (commencing with Section 7000) of Division 3 of tli Busir"ess and
a.Prccssimals Code, and my License is in full force and effect.
License # Lic. Class f Exp. Date
3 . C53 d3113C
Xte Signature of Contractor;, > _/Z*
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 Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 229>01MI01034
(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
sl jbject to the/ wor ers' compensation rovislons of Section, 3700 of'the Labor
ode, I shaJ1rf1fo0Wth comply with those provlslons
Date: S J Applicant
Warning: Failure to secure Worker's' Compensation coverage,is unlawful and
shall subject an employer to cri6iinal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section'3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter 6pon
the above-mentioned property"for inspection purposes.
Signature (Owner/Agent) 1 Date T_
BUILDING PERMIT PERMIT#
DATE" VALUATION LOT' ' - TRACT
11.3.16 WAI'C
JOB SITE APNAA r
ADDRESS 44-215MAW0NA COTMT
OWNER CONTRACTOR/DESIGNER/ENGINEER
Ia4Ae'3AA ,! AN1 RA:L;ilAMPTON dLa'; AC;.A,MONPOOLS
44 -215 MAW 03 ,: COURT 9522 DONALDUIDN RTD,
LAQt7IMA vii 9225$ LU CTMNEVAULEY CA 9u356
(909)249 604,5 C-SL4;i 4335
USE OF PERMIT
POOL A 1011.9PA
POOL & SPA ONLY-ALAi2Iv1SIBAF MIERS SHALL BE T`N PLACw AT
PR&PLASTE R INSPECTION,
VALUATION 1300A i's 1
y
War FEE SuAndwy
Pi 114 CH 9CIC r,EEV: 101 -OW-439-318 $99.45
CON.';TRUC'TION1FF, 101-o0o4118.000 $153.00
MECHANICAL FU •- POOL 101-1000-421.000 $24,00
f—eLEC:'d'Wc..w,,4-L YZLt' <- POOL 101-000-420-000 $45.00
}'1,1 'hf 3 I:a 3 SEE - POOL 101-000-419-000 $27.
SUB-TOIA.L CONSTRUCTION AND PT AN C IECK •I $345.45
LESS PRE -PAW FEFF9 $0.00
RECEIPT I DATE
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 Wail 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
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
Z
Gas Piping
Gas Test
Appliances
•
Final
� p
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)
,tt k - - lS, VACATION POOLS & SPAS
9522 Donaldson Road
Lucerne Valley, CA 92356
(760) 248-6045
(760) 248-2919 FAX
' Lic. #C-53-351673
- Sales Locations
' •• ' .`' Bermuda Dunes, Irvine,
California City, Rialto,"
:z z. Lucerne Valley
1 800 999-1811
G P CIFICATION
; . r SIZE 3' X .2 S'
`/ H ''' AREA PERIMETER
• - y 3 - __ DEPTH
- µ
C INSPECiCON 'FEE
ARE- TILE CHOICE SQ.
__ ----, ---- — a: - - RBB.
Q2 WILL BE CHARGED IF THE APPROVEDcoPING s w c1 %+g
PLANS AND 106 CARD ARE.'Nff '011`, POOL CAPACITY GALS
' 9 THE SITE FOR A 'SCHEDULED PUMP CAPACITY GPM
jON. MOTOR HP HP
TSO y - AO EXCEPY MOTOR HP HP
-r. FILTER SQ-FT
2 } G ; ,; FILTER RATE GPM
- — --- ?
SIZE
HEATER BTU
•
-
TURNOVER HRS
CITY OF SUCTION LINES
QU NTA_._ RETURN LINES
- BUILDING & SAF
f ETY DEPT. SKIMMER MODEL 5
w ,n
APPROVED"" ' " CHECK VALVE
/ GASLINE BY P FT. l I
FOR CONSTRUCTION , POOL LIGHT 3oa CLOCK e-S
` 1 ELECTRICAL BY P FT. 11
DATE=-- ,6BY AUTO CLEANER
r-_ CHEM. FEEDER
i - _
C PLASTER COLOR W %
.. • - -
- DECK BY P SQ. moa
DECK TYPE
STEP -S FT.
, d , ► G _ q 3 S 6 qq SPA SPECS.
r / 'J SIZE RAISED G - •:
j/l! `1 ' -r LITE O WATTS
DUAL LEVEL SEATS''-,&;Z " vt l N
' DAMWALL 3 `
DAMWALL TOP 7'7 1'
t SPILLWAY SIZE 6 " X /8" WIDE
{ CONTRACTOR cannot assume .responsibility for DATE SPILLWAY
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 roe/y%/ q,ve.S.
9 9 property
rtY
it is understood that you, the ;.owner; have that Addre y(S /Yla j^; p 'S9
neighbor's permission and assume full responsibility.
„ ...
city-
q Qu'n1 '9`
DATE- TRACT . _ LO
T#
SIGNATURE
P.O. BOX 1504 No. 05156
Building78-105 CALLE ESTADO
Address 44-215 `:• ariposa Court LA QUINTA, CALIFORNIA 92253
Owner L
Mailing La Cuinta Assoclates BUILDING: TYPE CONST. OCC. GRP..
Address A.P. Number
City Zip Tel.
'1101— A 1 n 7.9 0 14 4 r ' „ 7 Legal Description
Contractor Project Description T e DJ 13" tom- T,^:t 11
n s a • ♦.., n n
Address ..., _ .:'r. , .
City a "' Zip Tel.:
State Lic. City
& Classif. 493319 Lic. # 1231' Sq. Ft. 1336 No. No. DIN.
Arch:, Engr.,
Size' Stories Units`
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect
r
_SIGNATURE DATE
OVINER•BUILDER DECLARATION Estimated Valuation
I hereby affirm that 1 am exempt tram the Contractors License Law for the following , ,
reason: (sec. 7031.5,8uaness and Professions Cade: Any city or county _ which requires a
Permit to consbuct, ater, improve, derma sh, 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 PERMIT AMOUNT
the provisions of the Ca dractoes License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Pro/essians Code, or Mat. he is exempt therefrom, and the basis
for the affeged exemption. Arty vkd3wn of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a coilpenatty of not more Man five hundred dollars ($500). Plan Chk. Bal.
❑ I, as owner of the property, or my employees with wages as their sole compensation, will S 2()1q. 9 4
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisne'ss and Const. Professions Code: The Contractor's License Law does not apply to an owner of property who ►- 3 5 5.00
builds or improves Mereen and who does such work himself or through his own employees,
Provided that such kri rovemwnls aro not intended or offered for safe. if, however, the building Mech. 33.00
or improvement is said wiAn ane yea of compiet'm, the owner -builder will have the burden Electrical
of proving flat he did not did or "improve for One Purpose of safe.) 65.44
❑ I, as owner of the properly, am exclusively contracting with licensed contractors to con- Plumbing
struct the project (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not appy to an owner o1 properly who dads of improves thereon, and who contracts for S. M.I.
such Projects with a confrarlarrs) icersed Pursuant to Me Contractor's License Law.) 5
❑ I am exempt under Sem a- & P.C- for this reason
Grading
Driveway Enc.
Date owner Infrastructure 1.648.78
WORKERS'COMPENSATION DECLARATION
1 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, Labor Code.)
Policy No. Company
O Copy is filed with the qty. O Certified copy is hereby furnished.
x TOTAL y,St•R. /^ .(, +
CEATIFICATF OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE
(This section need not be competed if Me permit is for one hundred dollars ($100) valuation
1 d,
orless.
1 certify that in the performance of the work for which this permit is issued, I shall not t X f #tL 4rit3}f • 3 k
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of Califomia
Date Owner
NOTICE TO APPLICANT. C, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Mbrkers' Conga saian Pvavisios of the Labor Code, you must forthwith
Comply with such provisions orthis pemmishalfbrdeemedrevoked . Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued- (Sec. 3097, Civil Code.) Side Setback from Property Line
Lenders Name
Lenders Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 clays. 12/-29/88
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives .of this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, state, Zip
CONSTRUCTION ESTIMATE
NO. ELECTRICAL. FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SQ. FT.
HEATING (ROUGH)
STORAGE TANK
FORMS
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
DUCT WORK
ROCK STORAGE
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
DRAINAGE PIPING
CAR P. SQ. FT. ®
GAS (FINAL)
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN.
GROUT
WATER HEATER
URINAL
SQ FT ®
FINAL INSP.
ESTIMATED CONSTRUCTION VALUATION $
WATER SYSTEM
WATER PIPING
NOTE: Not to be used as property tax valuation
GRADING
cu. yd.
plus x$
FLOOR DRAIN
MECHANICAL FEES
FRAMING G �C% FINAL INSP.
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1+/4 c
SEWAGE DISPOSAL
SO.FT.GAR ® 3/ec
HOUSE SEWER
!
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
OUND PLUMBING :4�5-UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR S
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
eETER
LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
$
GRADING
cu. yd.
plus x$
=$
LUMBER GR. NAL INSP.
FRAMING G �C% FINAL INSP.
ROOFING S �
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING A
MESH G
INSULATIONISOUND (J 27
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
� � (�
� �3 Q �
REMARKS:
!
i
11NSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL