RPL (0208-076)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
332fi12 C53 CIO U81.41M
i
Date 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.
(ac;) 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 STNIW IqW) Policy No. 229 -MM
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
n.ro• - e.,,,r—t . ..
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 (Owner/Agent) / Date
•
BUILDING PERMIT PERMIT#
620; 076
DATE few/20V VALUATION
ew/2 VVALUATION $1010W.W LOT 1- — TRACT
JOB SITE
ADDRESS V-391 AVFNIY)A,�ilFd� )KIVA
APN ^
OWNER
CONTRACTOR / DESIGNER / EN (NEER
.52-391 A."VENIDA ilii. WZA
81.565 81JAMM.AVR1R 113,
LA QIAWrA CA 92253
I D10 CA 92202.
(760)347-3218 Cf" 5.238
USE OF PERMIT
PC1 L AIV'2:Y(YR SPA
POC9 A SPA CINLY AIAAf MWBAfr 32li<i1t' SHAtl, BE R4 V1.ACF Al'71>RX
PI.A.R7'I.t[�;(i ,`P'�C'i'EO)OW,AQ�TIPMEsc�'l� ENOAYATRUK X W>7'1tdt'.i,UDJ?fl
in Ft1Rhxr
mi t YEE scttvuv[hRY
PLAN (;1• FICC 11,M t01-• XV -439-3 18 $76Art
C01dMTlt;'I ON FRR 101 0i 0 il. ON S117100
Tvi MLiXXICAL, M -- PM]. 101 -421-000 $'&W
11S12tt'TRtC Aa.'f+l3li •• :f'T?! 1t, 101 -{!W -4120 -'km $45.90
F1A1MC1i1M IrM -- POOL 101-W�-419-000 $27.00
SM -'TOTAL CONMR1.TC,110N AND PLAN ME CK
$2,99.05
I.EW ) 0RR-PAX)) FVRA
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TA -1. FRVVIR
rF'7.y•f)
MAY U7 t«UZ
CITYOFLAQUINTA
FINANCEDEPL
RECEIPT DATE/ /
BY �_
DATE FINALE
INSPECTOR
,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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
Set Backs
Footings
Steel
Electric Bond
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
p
Gas Piping
Gas Test
Appliances
Final
r7
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
low Voltage Wiring
Fixtures
Win Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
t
Final
Utility Notice (Perm)
r
�f4 ,
CITY:OF �-p` QUIA DEPT,
BUILDING SAFErY
APPROVED
FOR ONSTRUCTION
'1 oti Nb,
Si
Ca -
y
i
6-_
� I S
-06
j
r
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I
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LAkIfL�,rz
Z-391
r� t
e 76 D 56 yYUVD
A CUSTOM POOL DESIGNED
ESPECIALLY FOR:
MAP PAGE NAME /-%/- 0/1,FPL
LOT ADORES
TRACT ` CITY c .
APN X STREET -
HOME P►{ eye �{V BUS. PH
PUNS BY CHK,. --BY
DESIGNER
FOOL SPEC-IFICATIONS
sQ ; _ SMAPIE _ _ M
PERI * AREA o
oEpmax_x-5-7 v�oLUlw��g0�
EXCAVATION
RAMPS_ GRADING
SWINOUT zyo FENCE
SPA: -,_'-'CONCRETE__ RAISED Ba_ -
mlSC.
STEEL
SMnMOUT LOVESEAT RAMP
SURCHARGE POOL LIGHT ",Z
RAISED BOND BEAM SPA 29
MISC.
PLUMBING
SUCTY-f_ RET!Z, PUMP-
SOLS , e-' POOL SWP.
HTy L�Z-FILTERI•.yG ` FILL LINE
SPA -q SPA LIGHT /ti�AET L,;!E"JETS--4--
BONDING
PATIOS._ DIV. BD.
SLIDE OTHER jmlF£
GUNITE
RAMP NOTCH B.B LOVESEAT
RAISED BOND BEAM SyM __ P.S. STUB
SWIMOU? SPA__ ANCH
MISC.
TILE & COPING
TILE WAT"iE'ZL'1.4 _ COPING
TILE TRIM <-� ��- SPA WALL W 'ITH
SPA- RAISED B.B.
MISC.
PLASTER
COLOR 1,4 ) h , SPA
DECKING
BYOIIJ efgTYPE SO FT
FINISH
ELECT BY
sPc. INW.
GAS BY w/�F
SPC. INST.
ADDITIONAL NOTES:
0"ER:
POOL AREA TO BE FENCED. PER COUNTY OR CIT
ORDINANCE GATESTO BESELF•CLOSINGAND SEL
LATCHING.
WET DOWN CONCRETE SHELL AT LEAST TWIC
DAILY FOR 7 DAYS.
DO NOT TURN ON POOL LIGHT WHEN POOL
E11PTY.