RPL (9910-075)LICENSED CONTRACTOR -DECLARATION
Thereby affirrri,under penalty of perjury that I am licensed under provisions of
lithapter 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
5141:2'i Ig 0&13
X, -
Date Alla. Signature of Contractor ✓ ", re> Y
OWNER -BUILDER DECLARATION' -
1. 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 construcf_the project '(Sec. 7044,• Business & Professionals
Code). ti ;
O ° I. am exempt under Section B&P C.' for this reason i '
Date' Signature of ..Owner
WORKER'S COMPENSATION DECL'ARATIONM,
_ t,
I hereby .affirm under'penalty .cf:perjury one•of the following. declarations:
() I have and wIllI 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. , a
(1lS :l have and will' maintain workers' compensation insurance, as r'egwred 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:
Carver • ' Policy No... ,. .
A W PIMP -W07934
(This section need`not be completed,if the'permit yaluat,ion+is for,$100.00 or. -less).({) I•certify that in.the'performance of the work for which this.permitiis issued;
I shall not employ any person in any manner Iso as -to become'subject.to the
workers' compensation laws 6f California, and agree that if I,should.become
subj4t to�}the workers' compensation provisions of Set tion ,3700 of the Labor
dp°4e %c /idil ithAPPlipanwth V27 _•
n`
Warning: Failureto secure Workers' Compensation coverage 'is unlawful and
shall subject an employer to criminal penalties and civil'fines' up,to $100;000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.. - . <
IMPORTANT. Application is hereby. made to the Director of. Building and Safety
for a permit subject; to : the' conditions and restrictions .set. forth on.. his
application..
1. Each person upon whose behalf this application is made & each person at
Whose request and for whose benefit work is performed under or. pursuant to
any. permit issued as a result of this applicaton agrees to, &•shall;:indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2.:Any permit issued as ares It -of this application'becomes•null`and void if
work is not commenced within 180 `days' from. date' of issuance of such
-'perrifit, or cessation of work for 180'days will subject permit to cancellation.
I celhify that l'have read this application and state that the above information is
correct: I agree.to comply with all City, and State laws relatirig.to the building
con5truction,'and hereby authorize representatives of this City to enter, upon
the above-mentioned property for,inspection purposes s .
Signature" (Owner/Agent) T ""''' v'�ti' Date✓''
PERMIT #
BUILDING PERMIT.,.:,V
r
DATE VALUATION«g=0� LOT TRACT .
JOB SITE)
ADDRESS �''.� xMI�.�%�Hti
APN
.. ..
OWNER
CONTRACTOR / DESIGNER / ENGINEER
9li IAN aM1 .A3I1"'
F..,A.,ei i..:v eMacP�la,.,i ,
C ��'S34" 1lf�tCl�i1FY9�F1 Atl'4`^ 19L'T/ K)5�� �
_.,r V L .,ni.. ctare,.i Eti :tl.. iti„✓��.. a s,. s.
d ,.a, (j tFl .t '.ICII�a '' . ,..:: ,
7301�:Ct 1 b� #i.Yr 1,.bUt 9J:i;.,, �I�`.E '
L �h,QU€6�l'�A, �C,A W225'3 •
RA.LM t"3���,kl' T - = 'C'A. 42260t
t i�a4�ia 3 .403'2` C .��,# t044.
USE OF PERMIT
POOLANDJOR SPA
va da1tlSkP1t�:LLlX/. �i�8 >ji� i+.A; h1UPI1.i' ..:. �.
�t�.t•:"1C��Cii�Yd sd1 �f��!',i:.<; t.��%�f r
_ OOL AND11101 WA 30.0.60.(14 LS
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X-S';t.R .:ED ''€ `lC•: ' C� ;�';.`��J "' � 3',:',.'..,.
, ,`($'j
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•- •�H.p/ny eQ�/e•,p...),y'{, (. '•,A,
Y..iV.Y .4':\:I.Q�✓ 1�/�$1Y.a,F��,•.;1I M ,�, b�
5
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✓d1s�
Q✓` NMII }0.t.+•...*.Y, .��?F-�.i'E�� �i!t �lK',:"u��C1'�i`1J . � :.T �A74 50
it9l�c"1 ANTC iV., � S, — POOL 61.4 A-421
%� t?t.;'�11�.CC /1�. is �Lti`•�-'?l`��t � ��Y-c�ri���s�-l�t�F� '' a.U?.i
. .
;'MUMBING 1"RE POOL 1.fJd-fl9Jii-�6�.�:•(.H� $2J.Uti
chi,M_•-TQ+`AD.,4 COXFT. R l(MO_°,N!ANT)P3s N. ['BEM
LESS'P�`t`C"'&AID FEES
Spin"
•. - �d SY r -A W�. D'v 0.tlA!'U I 4�,tl'rY,n l7 &.f Y), v �.N ♦Y
'.i�. i.4.
RECEIPT
DATE , �.
BY
DATE FINALED
INSPECTOR
YO
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
Set Backs
steel
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
Gas Piping
-
Gas Test
Appliances
Final
COMMENTS:
f{J
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)
1 t.0„
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P/L
REVISION ALERT.
(ADD PIA ON LEFT SIDE
OF ROUSECHANGE DWI IS)
I
G/B
.. 11 - . ' .
OBCAT ACCESS - '
O R&R
P/ 18,x"
SLEEIE ALL
5' .
8'-9" 1 �� „ „-9 ;
„
1:-6 " 16
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ITW -71-014
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P/L
CONTRACTOR cannot assume responsibility for GENERAL SPECIFICATIONS
damage to curbs, sidewalks, driveways. cement SIZE 16 X 28 .
slabs, sewers, lawns,trees, fences: retaining AREA 373 PERIMETER 82
walls, sprinklers, telephone lines or shrubs. D 4'X6' ,
When access is made through a neighbor's
pmperty it is understood that you, the owner. TILE CHOICE GROUP 3 SQ. 75
have that neighbor's permission and assume full RBB, 36'@+6"2'@+12" 10'@+18"
responsibility. COPING CANTILEVER
DATE _ signature POO CAPACITY11,000 GALS
PUMP CAPACITY 103 GPM
AIRPIPE MOTOR HP SIA grrF p 1.5
A RE -INSPECTION FEE OF $30 MOT" "Pm m"Pm
I'ILL BE CHARGED IF THE APPROVED FILTER STA RITE 300 SQ FT
PLANS AND JOB CARD ARE NOT ON FILTER RATE 102 GPM
THE SITE FOR A SCHEDULED HEATER LAARS SZE 400 BTU
INSPECTION. TURNOVER 2 HRS
SPA SIDE SWITCH .SUCTIONLN 2 "
RETURN LINES 2 "
IM ER MODEL AMERICAN
REVISION ALERTCHECKvALvE YES
GASLINE BY ' SDC FT. 170
(ADD WATERBRITE) POOL LIGHT 400 IN CLOCK JANDY
ELECTRICAL BY. SDC 400
AUTO CLEANER GREAT WHITE
HEM. FEEDER WATERBRITE
PL STER COLOR PEBBLE COLOR TBS
DECK BY SDC SQ. 1004
DECK TYPE SLT FNSH COLOR TBS
Wpm m=mIii"mmm�
REVISED SPA SPECS.
9-23-99 SIZE 7 RAISED YES +18"
LITE 100 WATTS
"TWO 4' HIGH STUCCO BLOCK RI LEVEL SEATS 22" 24" 27"
%WINGWALLS DESIGNER DAMWALL 6" X 8 FT.
DAMWALL TOP TILE
JOHN/EV SPILLWAY SIZE 3 " X 12" WIDE
DATE PILLWAY XX OPEN CLOSED
9-20-99 #j S 4 UPER LOWER
Name: STEVEN WALKER/SEARS
WATER BRITE '
Address: 80-150 MERION
CITY O F LA
�Q:U� I NTA Q41 LA QUINTA
TRACT RYDER LC)T# 11
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE _ BY Lr'
J .I PALM DESERT
N 73-011 COUNTRY
1/9
II 1 CLUB DR. STE F-4
TAj
PALM DESERT .CA.
NOTES LANDSCAPE AND FURNITURE 92260
ARE SHOWN FOR ILLUSTRATION (760) 346-4032
ONLY AND ARE NOT INCLUDED. . , U .
TEMECULA
28910 RANCHO
CALIFORNIA RD.
STE 206
TEMECULA CA.
92590
(909)676 -SWIM