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RPL (9908-163)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of,perjurythat 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 574127.. ate rf U� "Signature of•Contracto� r�''�' s ' . OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that'I ,am exempt from the Contractors License Law for the following reason: O 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 :prop erty, am, exclusively contracting withlicensed contractors to construct 'the project (Sec`. 7044, Business & Professionals Code). r O I-amexempt 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, Yfor the performance of the work for which this permit is issued: ( ' I have and will"',maintain workerscompensation 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. - . a:f SI a,y9v-ren•. - rl;i6 .M+- H^!aa • iHAll` (This se-ction'needTnotbe completed if the permit valuation is' -for $100.0.0 or less); ( )' I certify that in the performance, of the•work,for which this permit is issued; I,shall ,not employ any person in any' manner 'so as to become subject'fo the workers' compensation laws. of California; and, agree'that if I should become supject to.the workers' compen§ation prgvisions.of Section 3700 -of the Labor Zde, I: h II fo hwith comply tho ee���provlslons. i te: Applibant�" p Warning: Failure to. secure Workers' Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to 1100,000: -in addition to the cost of compensation, damages as provided for in Section.3706 of the Labor Code, interest.and attorney's,fees. IMPORTANT Application Is hereby made to the Director of Building and Safety for a permit subject to.the'conditions. and restriction's set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as aresult of this applicaton agrees to;.'& shall,, indemnify & hold harmless.the City of La Quinta, its,officers, agents and employees. 2. Any permit issued.as a "result of this application becomes null and void if work is not commenced within 180 days from date of.issuance 'of such permit, or cessation of work for 180 days. will subject permit to cancellation. I certify that*l have read this application and state that the above information is Correct. I agree to comply with all City, and State laws relating to.the building construction, and hereby 'authorize representatives of this City to enter upon i t�e above -mention; property. r Inspection purpose V Signature (Owner/Ag nt) / 'Date��� PERMIT# - BUILDING PERMIT DATE 0812f fil."VALUATION ; �J:��r.Eetl� LOT • TRACT JOB SITE ADDRESS. W268 ABY ', .lIQ'i JAPN - OWNER CONTRACTOR/DESIGNER/ENGINEER ST LAMN W.N1,102R. Whp:k?S (MON 71.61 lNxa$ iSM AVE..'13011. COUNTRY 'CIA S DR , SWTV, F4 P^1ki±�L�TV1.�X1: 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 8 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 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 f Gas Piping Gas Test Appliances Final COMMENTS: 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) 144 zP/L CONTRACTOR cannot .assume res onsi i14 for GENERAL SPECIFICATIONS . .r damage to curbs, sidewalks, driveway s� cement C f . i r ,. �� SIZE X 27 r , SPA @+12" 7�_g" , � _- $labs,�er;�lawn . r es, -fences, j ainmo t walls sprinklers. telephone 1(nes-oi shrub's.-- AREA 253 PERIMETER 78. <; '- e r 41" 3X5 ,' 3X5 • txt,::' • n= s.,<,, G , .. t.s When access is made through a njighbpr sDEPTH r e it is understood that .you, the owner. TLE CHOICE - GROUP 3 SQ, 65 have that ne'ahbor's permission and assume full2'@+6" 8'@+12" responsibility. COPING CANTILEVER 1 - BENCH " ' DATE signature P 9,700 A >:, sem_ g A4iv: PUMP CAPACITY 103G PM AIRPIPE 1� 0 " , MOTOR HP — — — r-01 1 t -0 �. 1S" Co "7 �' MOTOR HP HP: - • BAND IN SEPARATE COLOR • R 3-,19'-0.. ` FILTER S-rA RITE 300 SQ FT ', / ,•, i s ,.•, 5, J • 2,_3" . GPM • P3=_61' " 3' x FILTER RATE - •• • • e � • -3 ; 7 < � , . � • • ' � • v_ ; - HEATER RS SIZE 400 BTU•. C _.'- .. -f Y• ^A 1i ''^ - • — — . a•• -. TURNOVER HRS omBENCH � 3-6 NOTE BAND c12" N LINES 2 F ; _ a • 1 s; �I l•;:.;�;:::v I LI � F :.r+EDGE ALL EXPANSION JkOINT:.S µ AND AT DECCO DIN RETURN LINES 2 AMERICAN04' I MRM „ I .;; - r ', '4: YES _ - I - . ( y.: .. ' GASLINE BY SDC FT- 163 — `• • — —, °'..21� 9^ I I I : , ` "- POOL LIGHT.400 W CLOCK �_A RE -INSPECTION EE OF $3Q., I r WILL BE CHARGED IF •THE APPROVED ELECTRICAL BY. SDC, �' `' GREAT WHITE ! _ AUTO CLEANERPLANS. AND JOB CARD. ARE NOT ON. }, THE SITE *",FOR' A SCHEDULED. . h I x I 0F�Fng 'Room w 3 INSPECTION " �' PLASTER OLOR WHITE ;.�. ' ' - , r, _ - . •. �" NO EXCEPT k DECK BY ' SDC SQ. 1068 - " DECO DRAIN I �! , c, DECK TYPE SL FLASH TBS �,' ', STEP' FT. lCitchert SPA SPECS. F T - 4,. . SIZE TWO 4'4' 7 RAISED YES +12" STUCOO BLOCK' LITE • 100 WATTS • S N'� NG WALLS AQUASWITCH ? a RI LEVEL SEATS 22 24 27 f�YTngL iA00117 ;- DESIGNER DAMwALL ' 12" x 7 FT. i10 ceing DAMWALL TOP DECK " r ©.� r JOIHN/EV • a .. SPILLWAY SIZE 'i X WIDE P/L,>. E t �I Yr: DATE P L W Y XX N- L -. 7-20-99 # JETS' 4 R OWER P/L. 4 WALKER HOMES/ JOHN SUYDAM r Lound, f' ; wet I , 4 bor• r • . dress. 80- 268 MERION, - Qdyi LA,QUINTA _ BRACT RYDER 20 a ®® soll i . PAWAC PALM DESERT TEMECULAN. . 73-011 COUNTRY 28910 RANO J -IO •s • OBCAT ACC'. ESS - I' + CLUB DR. STE F-4 CALIFORNIA RD. • - 0 R&R ACCESS = PALM DESERT CA. STT 206 ' LANDSCAPE AND FURNITURE 92260 TEMEcuLA CA. ' �'- ' UdrboRi N� BARE SHOWN FOR ILLUSTRATION 346-40322 92590 •. (,209)6Z6 -SWIM " ONLY AND ARE NOT INCLUDED., _ ' . LIC# 74 7