RPL (9910-077)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
;'F ;;()fessionals Code, and my License is in full force and effect.
License # lic. Class. Exp. Dated
UDatg�. , j` "r.„ Signature of Contracfd-r
T r
- OWNER -BUILDER DECLARATION: '
I'hereby affirm under penalty, of perjury that I, am exempt from the Contractor's
License Law.for the following, reason:. - r
( ) 1, as owner of the prope.rty,.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). '
O 'l 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 Coiie,' for'the
performance of the work, for which this permWl§_ issued. '
( I have and will maintain- workers' compensation insurance, as. required by
Section 3700 of the,LaborCode,, for the'pedormance-of the Work 'for' which this
permit is- issued.: Myworkers' compensation insurance :carrier .& policy no.- are:
Carrier Policy No.
* ;.a r i •fq9 •i'rL'r�tY� r ' 'c5 0: -,ir<S�*/a'v m ,
!'Vt NJ 53.� 4-0:'Pi
Er l 'Pi
(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 iwany manner so as to become subject to the
workers''rcompensation laws of California, and agree that if 'l should become
sub'ect to the workers' compensation provisions of Section 3700 of the Labor
C de; I shall fort�ywith comply with those piovisions: • .- i,
aIe : !/.%.�;1` Applicant-
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 37Q6
of the Labor Code, interest and afforney's•fees..'
IMPORTANT Application is hereby made to'the Directorof Building and'Safety
for a permit .sdbjpct'to the'.conditions and restrictions set forth on .his
application.
1. Each person upon whose behalf this application is made & each persorf 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 hammi ess: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.rl agree to comply With 'all City; and State laws relating to the building
conVuction,,and hereby authorize representatives of this City to,enter. upon
thZeature
above-mentioned property for inspection purposes
(Owner/Agent)y " � :! - � 2 . ' Datel �
PERMIT#
BUILDING PERMIT-,..-..
r.
DATE i VALUATION WT _ •,. _ TRACTJOB
SIYE
ADDRESS 6 �'�rt� I9sa�,r fik�T�t 7APN
-
OWNER'
CONTRACTOR? DESIGNER / ENGINEER
1'rr e'Ee4 'y.:l 1�.� 1. �I' .
a J.IY4 1111 l rr rr,4
i�vlla 15;. FO/` X} Li
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
`" a
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
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) '
Final
COMMENTS:
\
jtJ
.REVISION ALERTGOLF,•
_ �'1OT T / J ['1 �"? CONTRACTOR cannot assume reSponsibili y for GENERAL SPECIFICATIONS(DECKMESSLEIf[LE COLORS) BACKSIDE@ .12" lv U ,►\✓ jr-'1/ damage to curbs. sidewalks,_ driveways cement ,„
slabs sewers lawns trees fences retaining SIZE 15'6” X 296' � AREA 414 PERIMETER
walls. sprinklers. telephone lines or shrubs.
18" SHEET FLOW SPILLWAY When access is made through a neighbor's DEPTH 3X5 '
2' OFFSET �ropeerty it is understood that you the owner. TILE CHOICE TSO -647 90
-, 18" SET LEAVE DIRT IF NECCESSARY have that neighbor's permission and assume full BB. 3'@+6" 331@+12" 11'@+18"
3'6" —+ ----► — ( responsibility. COPING CANTILEVER
._� : — 71 DATE
BENCH I signature POOL CAPACITY 12,000 GALS
- PUMP CAPACITY 103 GPM
3 MOTOR HP STA RITE 1.5
9 - - ---. 2cy-,„-__--.__— — � AIRPIPE m iiil�.
• A RE4NSPECTION FEE OF $30
13 5 MILL BE CHARGED IF THE APPROVED FILTER STA RITE 300 SQ FT
�.� 12' .._ t1, .._ 102 -GPM
�- 15'-6^ PLANS AND JOB CARD ARE NOT ONFILTER RATE
/
HEATER LAARS' SIZE 400 BTU
THE SITE FOR A SCHEDULED
P/L _ 3,-y„ x>>^�; SPA @+18" Ip,;�Lj��rc TURNOVER 2 HRS
LINESTiON 2
- ,♦.._.:____ 16-6% 1suc
--
2' FFSET x,. �c °`•- RETURN LINES 2 "
ENCH i
. --- SKIMMER MDE AMERICAN
oraCHECK VALVE YES
SELECT STUB GASLINE BY SDC FT.90
2 OFFSET
BQ BY OWNER 3'6" OFFSET-, POOL LIGHT 400 W CLOCK
2T-9„
N.
25' P/ - ELECTRICAL BY. SDC FT. 300
P/A 1,911 SPA SIDE SWITCH AUTO CLEANER GREAT WHITE
FEEDER WATERBRITE
PEBBLE FINISH MIDNIGHT BLUE
DECK BY SDC SQ.1086
mooA $niniCi DECK TYPE SANDSTONE
STEP FT.
SPA SPECS.
SIZE 7 RAISED YES +18"
A91�1i� ,)REVISED LITE 100 WATTS
ELECTRICAL PLUG ANDY RS 6 = sY SDCALL 4 WIDE X 4 HIGH -16:&99 RI LEVEL SEATS 22" 24" 27"
DESIGNER DAMWALL 12 " X 7 FT.
_ DAMWALL TOP TILE "
RAISED BOND BEAM CROSS-SECTION mpOj�' an1Y1.� "� JOHN/EV SPILLWAY SIZE 3"k 18" WIDE
OUTSIDE EDGE FINISH $� �i�� WATER BRITE - DATE SPILLWAY XX OPEN CLOSEDL
WATER PROOF BOND BEAM #JETS 4 UPR LOWER
DECKING o 5-26-99
`iName* STEVEN WALKER HOMES/
DE d HAMLIN / SORENSON RESIDENCE
- NllN Address: 80-240 MERTON
iCITY OF LAQ U I NTAQtIL LA QUINTA
1 110 wBUILDING &SAFETY DEPT. TRACT RYDER PGA LOT# 17
GUNITE .bnuoJ V CGD
AP PR® Fr urCDw
and FOR CONSTRUCTION®�
-H, - ... f G/E �(
-BY
+" DATE 0
PALM DESERT TEMECULA
�,, tiiDa.�9r2taM
_ N 73-011 COUNTRY 28910 RANCHO
'CLUB DR. STE F-4 CALIFORNIA RD.
��-- STE 206
i PALM DESERT CA. TEMECULA CA.
' BACK HOE ACCESS NOTE: LANDSCAPE AND FURNITURE 92260 92590,
NO AcCES'S REPAIR ARE SHOWN FOR ILLUSTRATION (760) 346-4032 1;909)676 -SWIM
' ONLY AND ARE NOT INCLUDED..
— LIC # A-574127
s I,