RPL (9710-159)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chaoier 9, (commOP.cing 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, ale
38117 C' -i3 A
�(1 x%31/+.'8
Date a�9% 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.
( l 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 Policy No.
t: OIX)EN RAGLE NUIC-33186102
(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 sh SII foyy�tthwith comply with thio grovisions: {
Date: a 7E�I Applicant �^ -��1 . �.— = "E fUtti i aA\r1
Warning: Faille 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 propertyforinspection pZ;�JDate
I
S' ture (Owner/A ent' +r �1;�~�
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT �s9 TRACT 6161
S9,7'75.00
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DEANE HOMES
MASTER POOLS
,"60 MERIDIAN
73-555 HIOR SAY I I I
LA QUINTA CA 92253
PALMI DESERT CA 92260
i�1�3J6-ti!!5 CBL# 16
USE OF PERMIT
t
POOL ANIYOR SPA 9,775,00 LS
1' ST1?*1XFED COST 01r CONNIAUU140N
9,77S.tli!
PEiWIT FEE 80*11 ��ARY
FLAN CHFXK M 101-000-+139-318 S7605
CONS'I'RUCT(ONFEN 101-000-418-000S117.00
NIFA7HA,NI At, FEE --POOL 101-000-121-000 $2�7 0)
ELEC"I RIC AL PER— P00L 10 1-080-420-000 $15.00
PLUMBING MT- -- POOL. lot -ON -419-000 527.00
�L1r•L
SUB -TOTAL CONS"TRUC!'1ON AND PLAN CHECK
$289.05
OCT 2 7 1997 LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
S2li9.If:5
RECEIPT
DATE
BYMA Itl
DATE FINALED
I
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
J
Underground Pibg. Test
3
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
27/21512
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
11 97
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
r
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.
SmokC, Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
�Q
L
t h •
ACCUORAPHICS REORDER NO AG49715
- 6 i SPECIFICATIONS
Sin Z X ZZ Volume Gallons.
Template No. Shape •
Surface_' Perimger Vf. i
Depths: Mini rRynl -� Maximum �2'Brnk
Spa Sire IJ I P Volume Gallons.
I EXCAVATION
Finish Elevatic'.:
Access: to Preparation.
Grading
. Dirt Romci al/L s to Dur`r>p� �• 7fY r
Dry Well Location: f
Fence Removed By Replaced By stwisl
Size of Operti
r7 } NOTE: No pointing or matching of texture will be donel
.--=
PL BIN
.. r�Fll
Filter Type l nh5�rer
Pump Type V t Sin
Skimmer Typf _? n .- No.
Heater T _Sia
Hester Vent By
Jet Pump Tlrpa .:_' r--- Size
Blower Tyrill
Size _
Equipment LocatioP/C Slab/Pit
n s'
Plumb" Material 'r Feet.
Suet�on: Size �'" Length Ft. -;Discharge Size- L91h.—
Waste To_ Size Length Feet.
Returns in Pod: Number�Sia _ Lem feat.
Return Inlet Type .
` °� NM -Fill Line (With Obstrusti ns)Sira h ft. A/S Valve Fee:
f I,
I i
Gat Line By , Si l Length
Automatic Capering I A t
. • f SPA INFORMATION
{ Suction: Sire _ I gth. _ Ft. _Dischg.Size _- Lam+. — Feet.
1 Jet Type _.Number.
Jet An Line Number Un .—Length Feet.
I Blower Return Size Length Feet.
I
Number. Size•
t � Selector Volvo: Type:
t f Filter Type Size
Pump Type S'z°
Skimmer Type Size No.
P i t Heater Type Size
Hester Vent By
Jet Pump Type_ - Size
! Size
Blower Ty
pe
Equipment aa
•, r \ 1 , 1. ECuipmeLocation-- P/C Slob/Pit
Plumbing Material
Ft Discharge Size Lath. —Feet.
S3000 318V3I1ddd 11M aNd
Had Stl N0111f11V1SNl 011031'8(1S
NOIlOf1H1SN0O li0:1 (131d300V
AIItlN011IaN00
1N3Wlat/d30 A.1.3JdS V JNI011f18
d1Nino vi jo uo '
APPROVED:
A CUSTOM DESIGN FOR:
Designers & Builders Since 1958
73-555 Highway 111/Jensen's Shopping Center
Palm Desert, California 92260
619-346-6115
State License I C53-238947 DATE 10-2!o
I
o ;
2� y
Suction: Site Lenart_ Feet.
Waste Ta —Size Length
Feet.
- - - +--
Returns in Pod: Number Size Length
t
Return Inlet Type
Fill Line (With No Obstructions )Size --- J gth. _._ FL A/S Valve LocaF«
Gas Line By Site Length
1
Automatic Cleaning
e
STEEL
i
i
Standard/Special:
Raised Bond Beam: 6" ^ 12-. "r IS" ^'- Other_
Spa Dam Wall: Feet
+ e a + .r-�> �:'rf�t t'.L .
r ----
! i -
GUNITE
�7
inlets
.
. _ •
Corner Ra
_
\
Steps Fill Line L anon
Grab Rail Hand Rail-_NCup Anch s
Sest/Bench
Spa Information
AND COPING
�iTILE
z I �C�i%I•Y• i 1 LI;,N�7 t'C��L>
Tile Color Coping/Other -
(� "at✓'v�
i ! WAjk-r1'.IUL't.`� �`�1
Cantilever
Term Numbered Tile
1
Brick t 1
Special Detail: See!"STEEL": "GUNITE"
i ff
ELECTRICAL
.
ev 'rr--i Lroltt, S�_Cord Lerigtls Feet
'
are rlftish dimen5icins and all
b
"J" Box Location San td+ Locatio [ feet.
Filter Run Ft. et Run Ft. Light Run
Unless not0�d all �Imensions
are m top of mond beam.
Switch Run ft P nal Change
elevations
MASTER POOLS s SPAS WE interpret the meaning of any
Spa Switch Location
Heater Switch Location 'r+
part of the plans about which any Rasurtderstandulg may
arise.
Any deviations from dans shall be referred tb edin g
MASTER POOLS 3 AS or erifi�iOn before
DECKING
C-�
withwork. If Wont proceeds "ithout Cotractor
and assumes all hablhry he
By:v Finish 4+. Ft.
Rail Anchors
does to on his own responsibility
cantilever
may inCUr.
Risers Ft. Expansion:
Title to the plans, design, layout and specifications included
Standards: Board/Slide
herein remain the property of
POOLS a SPAS -
peek Drai
MASTER
Any use• reproduction• publication or distribution in any form
without the written consent of
or mattor in whole or in part
f'F ,TES POOLS 8 SPAS Is prohibltad.
�ha;l const`.tu:o accor'=r��
PLASTER
f 4 ; �
Lights 'A-1 Name Plates �RecesseA{StsDs „'"r'"`
J 1
Z�.�`--Grills�� —
�•,-; � CT�:a�t Y�i:h ttiasa p'_rs ..
Cup Anchors - `r Rail Anchors
Ci
DATE:
NAME
ADDRESS 7SPLET
CITYg�7--
-Z.
PHONE
AREA ' �;A .(aDWN. BYCHK. BY
sc 1 �—
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