RPL (9911-056)57161 Medinah
9911-056
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
X2,
ADate ✓'Signature of ContractDr'`
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 caiTier & •policy no. are:
Carrier y qy q Policy No.
Santfcr mm—) RRi C •'lVN"' .)6 ..
(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
subject to t e wo kers' compensation provisions of Section 3700 of the Labor
Code, VtVprftit' comply wi li th ase,pfiv sions.
Date: // Applicant
i
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.
Signature (Own er/Ageh"t)"-`- !.f '.-' ' Date
PERMIT #
BUILDING PERMIT
DATE imj ng9VALUATION 6la 34il1.f1 LOT TRACT
JOB SITE
ADDRESS 514-1.61 l l Jr!. 1 . APN
OWNER CONTRACTOR / DESIGNER / ENGINEER
r:3 f i 'i.1`A.T'6"l;`1'.?1'fZP Y.'w4'F `F,fr. 'i`fJ 4'1Si"f'1'hi 1^f%° k7 .11lplIr' sr ,, .
a—Cuiva.al. Csl AI f.f f Y l,. f. a.s 4J . \.f9% 4.i1.i1 e9A A. y k- 11 l a
904t3P71"BBLE I:ila.fl H DRI E ! k I CC,►illa'f,'n.ZY CLUB DR, SIXi'E r'4
LA. QU•IAl'1A CA: !?253 r°ti.LIM DEMO' CA 922,60
USE OF PERMIT
PC 9w ) 1.AN l.1/t. K fSVA
POOL AN!) 8P#.0NL - AJLATW,&T_rilW.1RRS SHALL BE N;iai., CM,- A :PRE
FOOL A1,RX(AR SPA 304M.06 LSA
> l"I'so IT VV,E SUMMARY
1,111ANi.H citFr
t`.CiTaS,T,Rvlr^T(0Nr€'sig, it) I4c Yi-418..( 3f1 SMI Rn
NTL'R ANfCAL FIM -- PCXX 1.01 1 V0
ELiG( 'ite3OV.i<fil-»N.. IIJ,
P.I.t1XIBINIIJ FEE #9d?(3t9 i:I.+iat
SI )H -'f 1 TA.1s c' ON t•° Tt ti r(;' f `T0N , t,1'+ D P , AIN' t' ; A, 1 -KI C. $565,
l3
RECEIPT DATE BY " DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Set Backs
steel
Electric Bond
POOLS - SPAS
N77
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
_
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing. Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
�010
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
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3
4:.VEPARERY .. - 3
-[-j1 '/ ',, ptAcb' t Is understood that vo. the deer_ TIE
ti' S"LLWAY UNDER V - III
"s• - . / CONCRETE CANTME VER CAP . _
COPDJG
AIRP[PE / DATE — 33gnaiure PCK)L CAI
" - \• -PIJMP CAI
. .L MOTOR K
"OFFSET % - NOTE. MOTERw
`\ -- R.Yfi' r ZT-6• —i GROUT COLOR CA -WAS FILTER
a + OFFSEr FILTER
HEATER
TURNO$ IJ -0•. 3 W-6' PILRETURN
'SKWER
s
BENCH ! REVISION ALERT NE
3 S CHARGE COLOR OF OECK.TRF-
EIiCIRICJ
-
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SPA SIDE SWITQ•1 - - I - - - 'AUrOft
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BBQ BY A7
GASIOR STUBS BY SDC
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MAHATAN
LrTE 1
JO 04SV LEVEL SEATS Z2, 24' 27'
DATE DAMWALL 18"X71 FT. -
` DAAMfALt TOP
. • ._ `' aNlNO<Z 9.1a9D SP✓LLWAY Siff 3" X 18" • VACIE
' MOOR REVISED XXCFEN CLOSED
L DANDY RS 4' fo 11
- - 3W X4'FLA FERNS EIN
. - a WAIISBY SDCC
lAOCkmCw
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IRA CI•AUGUSTA S 4
BOHCATACCESS m
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NO RAR
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PALM DESERT TEMECULA
-- - 73-011 COUNTRY 28910 RANCHO _
fBT7AM V"3 CLUB DR STE F-4 CALFOPRA RQ
NW - _ _ 118'=1' SCALEPALM DESERT CA. T ECULA CA.
erawvt ONOTE- LANDSCAPE AND FURNITURE 192260
Qwmaom ARE SHOWN FOR ILLUSI`RATION n 3464032 92590
" R (9 676 sw e
ONLY AND ARE NOT INCLUDED. '
T
- m
- N
-SIT & SPIN SPA VERTICAL
FINISI-bECK
<?0,
DECK
VENEER > .,:xi
18" SPILLWAY UNDER'
CONCRETE CANTILEVER CAP
a' I
SPA SIDE SWITCH
P/L I
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• V1INl0 ' -
MOOA
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DANDY RS 4°
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M]HDTIX
Lil
_ V1INAOM
M0031
NOTE:
GROUT COLOR CANVAS
GENERAL SPECIFICATIONS
SIZE 13' X 28'6"
AREA 381 PERIMETER 86
DEPTH 3X5
TILE CHOICE F -BONE SQ, 63
RBB. 11'@+18"
COPING CANTILEVER
POOL CAPACITY 10,900 GALS
PI IMP rAPA(7TY 103 f:PM
MOTeR"======EMP
FILTER STA RETE 300 SO FT
EATER LAARS SIZE. 400 BT
TURNOVER 2 HRS
LINESSUCTION .2
P/L . RETURN LINES 2-
'SKIMME MODELAMERICAN
LVE .. • .,` YES
REVISION ALERT GASL►NE BY SDC FT. 150
( CHANGE COLOR ,OF DECK,TILE, POOL LIGHT 400 -W CLOCK JANDI
:PEBBLE FINISH & GROUT) ELECTRICAL BY. SDC FT 280
AUTi9i `i.leM NIF- m
Ham,
EBBLE FNSH CLR SANDY BEACH
BBQ BY OWNER . DECK BY SDC SQ. 1276
GAS/GFI STUBS BY SDC DECK TYPE SLT FNSH OMAHA TAI
M o0 QL l
STEP FT.
C5 -b5'
SPA SPECS.
DESIGNER SIZE 7 RAISED YES+18"
LITE 100 WATTS
JOHN/EV TRI LEVEL SEATS 22" 24" 27"
DATE DAMWALL 18" X 7" FT.
DAMWALL TOP DECK
9-14-99 SPILLWAY SIZE 3"X 18" WIDE
REVISED SPILLWAY XX OPEN CLOSED
'# JETS 4, UPER LOWER
T, 611 f 10-11-99
TWO 3'6"X4'HIGH
WALLSBY SDC Names FLO FERBSTEIN 1 j
Address:
C-ftX; LA QUINTA
TRACT AUGUSTA LOT# 25
CITY OF LA QUA
BOBCAT ACCE SSBUILDING & SAFETY uEr I . '
NO R&R
&dsotq
1!,, APPROVED
FOR CONSTRUCTION POO/S
DATE' l BY PALM DESERT TEMECUILA
- 73-011 COUNTRY 28910 RANCHO
1/8"=1' SCALE CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. TEMECULA CA..
NOTE., LANDSCAPE AND FURNITURE 92260 92590
ARE SHOWN FOR ILLUSTRATION (760) 346-4032 (909)676 -SWIM
ONLY AND ARE NOT INCLUDED. .u # - '741 7
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