RPL (9910-074)LICENSED CONTRACTOR DECLARATION
whereby 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
374127 A ii8�;ilf�tsl
dg` Y
\Date tll� %' f�-Signature of Contracfor�-�"'�" �
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.
(V) 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 Policy No.
U fliND 046- "If 4A
(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 complymith those provisions, �;
,[,Date:' /, . %J ✓; <gpplicant.. _ ....e---';;;''w�-x s� ,�! y .`
moria: / �,..
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 inspectiori purposes.
-
F .. _ a or r
vSignature (Owner/Agent), .- ` °''� .!'F 1'�'jt
Date �
C
BUILDING PERMIT PERMIT It
DATE VALUATION y�W ���t jo . LOT TRACT
r
y�,1''i;kt 11.1�1iJr{�t3�
t,...
-,,I >4
JOB SITE( j /; APN
ADDRESS F, o -26o pOR-11�C�N .
OWNER
6(1-750 KHRION
LA QUINTA
USE OF PERMIT
x)L 4A3; Di6k N N,�.
1'khL ,YLAS'i',Blt
PiDO .. r"t,rvOK,,,,'R a A,
CONTRACTOR / DESIGNER
f/`}ENGINEER 4
Twf
-rf
73011 C'OU1 TRY Ci UH DR SWI? F4
Citi. 9?1':153 PALM, CA. 422460
(7 MM146_40_1111 ("Bill 110-44
M,1,iJ0 �Y0 L
! 1LY ^,�J� 14� �..'AI\➢ �.Y C1:ri a711t. bA MON
PLAN CHECK FJEY $214.50
(laNSiFf 1rT40TE 3'l�F It31 41 -d1 -iJ018 �4:�tSl f�O
&IFI "' DW11O X, r1aT, 1"1)1`A' 101-000-421-000 �tit,f�ta
W..1. ;TR1CF p :d .•:3�3f Yk. lti.i-4t�f�� l 4#-1��f1 $ S,liLi
1pi rJMl4tN(a F'31Cs 1131 49041441,) si+.ft11
SUR—'R1'FAL t''C?h]:c"9',R9'ii"°Tit )N AND it1 AN 4' 14FVI< I $640:V)
L "SS FIR
RECEIPT I DATE I BY , s I DATE FINALED J INSPECTOR
INSPECTION RECORD
r' 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
I
I
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
OLF COURSE . 22" WIDE STUCCO BLOCK PLANTER WALL . CONTRACTOR cannot assume respon ibili y for GENERAL SPECIFICATIONS .J.
damage to curbs. sidewalks, driveways, cement
i s'. ; • - ` , .s abs, sewers lawns,trees fences. retaining SIZE 15 X 37
I= ,
. v `' r PERIMETER 107 t
walls, sprinklers. telephone lines or shrubs. AREA 527 , 3X6 3
When access is made thou h a neigh DEP
" property it is understood that you, the owner. TILE CHOICE. VM 672 80
' . `-'�4r• t " have that neighbor' permission and assume full 40'Q+6" 10'C>+12".
i
r BB. '
', r COPING CANTILEVER
+12" • p 'RE-INSPECTIp TOPRONE. signature PCAPACITY 16r� A
IO'= J#ILL BE CHARGE CARD ARE PUMP CAPACITY 103 GPM
3 6 - - :'-0� PLANS AND 10oR A SCHEDULED _ ' • MOTOR HP 1.5
BENCH �. 71 SPA WIT SHE SITE . F v" L r' M!!'f�IRTIP�.� *per s,
I -0 ` INSPECTION. 145, FILTER
*STA RETE 300 SQ FT
.. r ryer,
NG EXCEP
V'2
..FILTER 102 GPM
l6' 3'-0 •
HEATER LAAR SIZE 400 B ,
\. «•. " - '
_ _4ti`° # -°• +6" ' ', -REVISION ALERT TURNOVER 2 HRS'
- SUCTION LINES 2,- .r
AIRPIPE ' rC)lANGE POOL'DECK)
���.. _-- p ,, RETURN LINES "
_._._,_._._... 1,2'' -- - _ 5 s}.? AMERICAN
IM E MODEL
• 4 " : r 1 25' OF LO E SEAT C ITY O F,:'LA QUI NTA YES
GASLINE BY SDC
- _h �' BUILDING &, SAFETY DEPT. FT. 160
DE
CO DRAIN "� pp `' C' POOL LIGHT 400 W CLOCK JANDY
------~ -- ---- -,-----,,---- —' — T----- ter R Ar .-APPROVED: 1®.V C® r ELECTRICAL BY. SDC 300
FOR CONSTRUCTION AUTO CLEANER GREAT WHITE
- 24._3 20'-0" ;r r , ; , . - c PEBBLE FNSH TAHOE BLUE
` " , . , DATE �. BY - p B SDC SQ. 1465
i • ' *- r "'� .; SLT FNSH COLOR TBS
DECK TYPE
�y7 . j i` ! • •
STACKED WATERFA L r STEP FT.
y ^ �•` W /ROCKY MOUNTAIN OI ARTZ • SPA SPECS.
' C r Y f J WATERLINE A CAP FOR CASCADE r' �^ SIZE 7 RAISED YES+12"
.Iz•
P/a • } �:aw:,>t '�< >• +9^ioror DAM LITE 100 WATTS
V;s WALL RI LEVEL SEATS 2 r, "
DAMWALL• STACKED
;, w :<<: r� <. =,v°<N ; . :: s DESIGNER
G/E•' -n: >:: kt>::.;; : ; I DAMWALL TOP UARTZIT�F
1 �»�tu.;e �'•:'./i::.{j"-:,: <:iY�iv:
WATERLINE
1 L•
.Rh i:y3R 'Ji•\,`ivy AlERLINE
r,:;: ;:;ka<' ::•r,, .:: ;.< :<_.<%::.;;. JOHN/EV �r
;. : ti ',i';r :,, ::�.•;: r �" SPILLWAY SIZE X WIDE
Dining Room '. :y;::: ,',;....: :Y :: :,: ':;
.. , :�4?, „�:. SPILLWAY XX PEN D
r.. DATE
BB
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JANDY R� .�::..
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Roan•
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LQ &19 14-
�' �18 WIDE•
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w,...; SPA DAM€ �I]l� HOWARD&DEBBIE GREENBLATT
0:.. h; \ Y:^! is 4?.i^.;:%?:�':�',, ry?:v
WALL Y��>�;,<w::;;:<��;..�� , ::.. Y�
Address: 80-250 MERION
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M n: :... �.,,<:, IRAQI STEVEN WALKEI<OT# 19
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Mester* &th ioR celt�I,p �,
STUCCO BLOCK 10A cep ink 00/s
EQUIPMENT WINGWALLS ter -+^ BOBCAT ACCESS,,
BY SDC -
'� • NO R&R NECCESSARY PALM DESERT TEMECULA
N 73-011 COUNTRY 28910 RANCHO
Entry I �I_ 1 CALIFORNIA RD.
CLUB DR. STE F-4
! ( — r r PALM DESERT CA. TEMECSTE�206
NOTE., LANDSCAPE AND FURNITURE 92260 92590 LA CA.
ARE SHOWN FOR ILLUSTRATION 4• _ 92590 {
(760) 346-4032 (909)676-SWIM
ONLY AND ARE NOT INCLUDED.:
LIC # A-574127 ,