RPL (9911-058)57221 Medinah
9911-058
LICENSED CONTRACTOR DECLARATION
Freby 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
D t,i* ` a _ Signature of ContractOf
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; wa des as their sole
compensation, will do the work, and the structure is not+'iritended or offered for
sale (Sec. 7044, Business & Professionals;Code).
I, as owner of the roe '
( ) p p fty, 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
Se tion 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 Policy No.
(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 the workers' compensation isions of Section 3700 of the Labor
Code, sh l(fo 4iP,comtp1y wit ,thgse prgvispns.
Dom,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines Lip 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 inspe'etion purposes..4-
Se ttig ture (Owner/Ag: „ ` ',7 - + C: t Date
PERMIT #
BUILDING PERMIT 9911-055
DATE • / VALUATION q ' - L a' vi7 LOT TRACT
JOB SITE
ADDRESS -GIt i .' TJY.[ k APN 6
OWNER CONTRACTOR/DESIGNER/ENGINEER
°; ? v 1: ) t C5:(SS+l' i It,1 'fi'. ii, t-,l
j0••x it:IJt?5ie 16 301i C0Ui4TKV 4-1Uf1 CCAs SU.ffi-,* j-4
I 4A QUINTA CA 922" PALM I)PSERT CA 422W
USE OF PERMIT
E'Z.)LA.ANf:)/L'* SM,
€'CKJI. A 50 e;€>,WWL"t : BE f Pisco ;E A VkE
VLAS EVA4,1N,%WV1(JN
1W -IL AMAI* SMA
16,ziN),00 LS
t l ti e1.#ffi COST OF
11-41"I f f Ful!,
V11AN(<f"EC!,1 tot 8 Sl1 01
. r,,ECT,'Cfc9AL J; ;jg-..I .c )i t(iJ ,l7(?(t- t2►? ifs w -t .«+s
PI,kIm1ttri(31• , -- 1x:)(°4f li1# 3)i}(►-:f3N-E1trti $'`i.t t!
X(RI-WaA1, C'faV;i"►RIX°'140N Anka 117AN(°gj}?c;€+'.
RECEIPT I DATE I BY .o' r 1 DATE FINALED I INSPECTOR
Y6,2r l8.60
r MX)
S99MW
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
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
OX 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)
OFF
J
-
AREA POUAIFTER 21
-
-
GOLF.COURSE
-
:s Nut the
owner_
pEm 36•cROUP7 25
Z
O
.- -
tmnd+a. ne:eNan/ Berm tmLa0d
__CANTILEVER
.mhwX JI
11•®-12'
-
•
-
F
CopM'
l
•
'
DATE_ - nature
I
m
_PUMP
rAPACFTY • IU1 GPM
N
-
MOTOR HP STA RITF 14pi.3
N
-
•
-
t
MOTOR HP - HP
ID
.
.. 1:^
FUER : STA RITE 300 . SQ FT
.
..
-12
GPM
W
r
•..
0
_
TURMER
P4_
FWMAN LINES 2
-0
-
-SKlftg
MOM AMERICAN
- 3
. -
-
OfEEX VALVE
GASLNE BY SOC - FT. • 190
.. ti
..-
-
POO[E[#FPKDO"1l L'L'0!K-•T100R
O
ti
-
-
-
- -
ELECTRICAL BY. SDC Er ISD
0
`C`•'in
MOR Wk4TE-
T
SDC gl4
O
.
DECK TYPE SLT FNSH COLOR TBS
0r r
SEEP
AUtPD-F-
512E 7 SPA SPECS.
TILEINSIDEa OUTSIDE EDGES
LTTE 100 WATTSTFU ;•
LEVEL SEATS 22' 24' 27'
/\41'-40
'4
FDEIIGNEJRtT-3'
ATS UPER
TB,lEANNf SWNG
t
1
_.
t
31'
m
-'ffii37-"1l►,ff INAFL
-
LA QUNTA
m
-
_
TRACIAUGUSTA -- LOW 31
A
•
4
IGH S
C09LOCK
1
GRr rl
/a/Y IY/I
Pools
N .
' n
ENCLDCkS
I 1.TSTYITCH
Dram
"TH
PALM DESERT TEMECULA
eY s
r
•
_
80BCATACCFSS
73-011 COMM 28910 PAN=
NOm7 R" -
CLw DR STE" CAL"Itt" RM-
r
_
-
- I+
c
F
PALM DESERT CA STE Z !<A CA
NOTE; LANDSCAPE AND FURNTrURE
92260 92590
ARE SHOWN FOR ILLUSTRATION
15T91 3a6 4032 {yo915765WIM
ONLY AND ARE NOT INCLUDED.
Lr aA-574127
'
a
`-
HIG14 STUCCO BLOCK,
?UIPMEENT ENCLOSURE
BY SDC
AIRPIPE
TILE INSIDE + OUTSIDE EDGES
i CONTRACTOR cannot assume respo6sibiliV fg[, GENERAL SPECIMCATIONS
damage to curbs. sidewalks. drivew�ys- c ment
51abs. sewers. lawns,trees, fences. mtainLm
walls. sprinklers. telephone lines or shrub& :AREA -38 '---PERIMETER- 21
EPTH
When access is made through a n�ighbor's 0 31611
property it *s understood that you, the owner TILE CHOICE. GROUP 3 SQ, 25
have that neiah6or's permission and assume full
EMonsobiloty,
DATE signature POOL CAPACITY
MOTOR HP STA RITF HPI.5
MOTOR HP HP
FILTER STA RrrE 300 SQ FT
FILTER RATE 1()2 GPM
HEATER LAARS SIZE 400 BTU
TURNOVER 2 HRS
SUCTION LINES 2
RETURN LINES 2
SKIMMER MWEL AMERICAN
CHECK' ALVE
GAS.LINE BY SDC FT. -150
POM "U"9091 MMK T 104
ELECTRICAL BY. SDC FT, 150
,P/L-
AAPT,& W&*NiFm'm m m m m m a
CHEM."C"m = m m m m I
PLASTER COLOR WHITE
DECK BY, SDC SQ.874
DECK TYPE SLT FLASH COLOR TBS
STEP FT.
SPA SPECS.
SIZE 7
LITE 100 WATTS
TRI LEVEL SEATS 22" 24" 27"
DESIGNER woo 10 to 00 0000
am. ic 10
JOHN/EV
.ego will
DATE
9-1499 # JETS 4 UPER LOWER
NameoGRANT&JEANNE BILLING
Address: 57-221 MEDINAH
Cbl LA QUINTA
TRACT AUGUSTA LM 31
G/E
NORTH PALM CILSERT TEMECOLA
-
TACCESS`
Of wAn,
w Poo/s
73-011 COUNTRY 28910 RANCHO
cLug DR. STE F-4 CALIFORNIA AD.
PALM DESERT CA. STt 906
NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA.
92590
LIC # A-5441 �7,
ARE SHOWN FOR ILLUSTRATION (619) 346-4032 (909)67.6 -SWIM
ONLY AND AWENOT INCLUDED.