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RPL (9910-227)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 Professionals Code, and my License is. in full force and effect. License # Lic. Class Exp. Date 4;71�t Date �Slgnature of�Contr p� 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. , ( ) 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. MATE A'MID (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 toJhe workers' compensation -provisions of Section 3700 of the Labor Code, I hallforth; With comply with thosdprovisions:°��a � `�, /Date: j'? �l 2_ Applidan'C '`y Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose be this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize, representatives of this City to enter upon the above-mentioned property for i pection,purposes., Signature (Owner/Agent, �'' -'" Date PERMIT # BUILDING PERMIT 5* 10 217 DATE VALUATION SZ.fJ`"t1�Ci LOT TRACT JOB SITE ADDRESS + �1 p ii i��A'.IRRIN APN z OWNER CONTRACTOR / DESIGNER / ENGINEER 90.294' ;301.. t COWIRY i LOB Dft., .iUITT, LA QLAN{A CA '9,tk 3 P.AI.M V)iSfLT CA 9124A) �Tci{l1?1�1fi <�EI ;v C)'d1i !:f 1041 USE OF PERMIT KX).L Ai,d 0 0 K SPA POOL ARD SPA AND HO 0? %,` ezc,MW�iUARk "' S SfIA..1 BE IN ,PL4%U Ar J1RE P1,AS17-_R INE..iK-;Ci'.1-0N- %.'i 1S 14 li, !ip, V.. BE It.—O UVV Y . 'rO ACER.1'IFILO APPLIANCE, POOL AN D'O.1V A 3;$,fJW.100 LS `?rTMc• T2,.T COSTO r° F'�a�i.�$e)��a�iis° ' �3i€uvi3.�5�9 PRRAOT FEEE SILi},i,IMARV C10N31rRTA''I'i'(V4 TI.VPI iIF.0". ME 4,Vg1f.7,A.ME •ly�)QL 101`Ii1311-421-00a 524.60. ,iXC1 R{EC'AL FEL -- f'i)OL. 5i.ti-10 PLUMBINUI VE -- V('90f. It, j"(W4i'4-OX) $`2,,(a? i� USS ( i��r�)[[.��,4�(i�a{lCy° � �+ S597f10 °!`WAL PERMI $° .Ra E EN DUE 7YiiW $597.60 RECEIPT I DATE I BY .r' % i r I 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 BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipmeit Location Underground Electric Underground Plbg. Test 14 -bl 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 141 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 Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: ` CONTRACTOR CTOR cannot' assume responsibility for GENERAL SPECIFICATIONS P/L damage to curbs. sidewalks, driveways, cement} ►. .,_ ': y� . slabs. sewers, lawns.trees, fences, retaining 'SIZE 14 X 286 ;•, •� �, • , t —�'" AREA318 PERIMETER' - LEAVE DIRT 1_ ` walls. sprinklers, telephone lines or shrubs, PALM SPRINGS GOLD `, .` When access is made throdgh a neighbor's DEPTH 3X5 R8' TWO 18" WID CASCADES BOULDERS NOT TO EXCEED 24"Y'...' property it is understood that you, the owner. GOLD QUARTZITE WATERLINE �+ STACKED JETS ► `" �, '' have that neighbor's permission and assume full RBB. 22'©+12" 10'q+18" !1, responsibility.COPING CANTILEVER P/L DATE _ signature POOL CAPACITY9,900 GALS PUMP CAPACITY 103 GPM RAISED BOND BEAM CROSS-SECTION MOTOR HP STA RITE 2 OUTSIDE EDGE FINISH . _ MOTOR HP HP FILTER STA RITE 300' SQ FT r- / y ' �:f- . <,k'+,''�•� � _ -.� I \ .- --\-' � -,� ', WATE.R PROF - BOND BEAM ! DECHING FILTER RATE 102 GPM "-6" /* H R SIZE400 BTU RADE TURNOVER 2 HRS'bench' STAP/ CKEDJETS R61.011 SUCTION LINES if nn RETURN LINES 2 AMERICAN e GUNI PE �`P/A �, SKIMME EL ' _ 7 # �.' * • \. _ , ATAC DWAT RFA I _ , ALVE` YES .CHECK '� ?,� W /RO[KY MOLNTAIN WARTY 4 t— r 7 :-� - " • w WATUMM h CAO FOR CASCA j j' h • 27'-9" DECO DRAIN Wit, t ' GASLINE BY SDC FT. 157 + ,3+ . _ �, :'• e. - :.. `w ei .trTOP OP DAM . . v< k>,:> »:: :_>: ::`.`':'i:r - POOL LIGHT 400 W ' CLOCK 'l4 > ' 1'• ,. �: 's °' WALL . P RS4 , • 1 • .) �'� �� r 'Ft x::0`:5.: •'r :SkL'?� is r.�p '•• i1 + . _' • , �..?.?�.:::.< ,� : ELECTRICAL BY: SDC 280 TOP.: L °( AUTO CLEANER GREAT WHITE 3. •` `�: •'� 4sa •y s:s£„?:IJ�t•. . �.:>:..: .b- -t WATHRLINB >' a yC :•ie":.y. ,T ; *'cl. PEBBL�E SANDY BEACH, <,»CH � Vii' <s«�;... :F�:���> � •1'1 ; r � DECK BY SDC SQ. 1140 %` 1 � ti /. . gat•' ;.r::,;.ji4; •18 WIDE C�f':';��„'.,::us�'�~;;:>>r"�� .:;3 DECK TYPE SLT FNSH OMA _ ::SPA DAMS : »:; : ;.:.. HA TAN <>' . SIT &SPIN SPA VERTICAL p/ ,. `� -tix . TEP' FT. r aw WALL'• . �s.:.: S � :r PINI SH D ECK SDS -36 BB B 11 SPA SPECS. _ Y OWNER 1 ��y _ 1 rnooA n •:iii � v... 7 SIZE >,• RAISED s. 11° SE YES+18 wG/E STUBS BY SDC � .- v:L^: ,:.0 , O 11 rcii:.:.� <.?i: . .. o h DELI{ :.s.«:z''ia..r,�;„e;r s .. i � - � ' ._ LITE ' 100 W 'r-' =«w r a ATTS VENEER .,- " ` 4#k P/A ,. ' 5 TWO STUCCO BLOCK w RI LEVEL SEATS 22" 2411 27” JANDY RS4", r "® DAMWALL STACKED r G TE Mi WINGWALLS , DESIGNER' r:5. _ tttOOA irit,= 1: : + o I _•f u.� + DAMWALL• TOP GOLD UARTZITE JOHN/EV SPILLWAY SIZE X WIDE DATE PILLWA XXOPEW CLOSED 10-22-99 . #JETS UPER LOWER Mme: STEVEN WALKER/ DANCER Address:80-296 MERION , LA QUINTA ' -, IRAC IRYDER LOT# 22 • ' .' • • • - - &e . < Aub `INSP Ci10N I'Ef OF O, _ - BOBCAT ACCESS A RE• `00 . - . v. - it100`1b9S '�9sabM NO R&R WILL BE CHARGED II: THE APPROVED PLANS AND JOB CARD' ARE NOT ON ., Po .. ' , '• . ' ` � - �'' ;,•9��0 '�'�� THE SITE FOR A' SCHEOUiEQ + INSPECTION. PALM DESERT TEMECULA' -RO EXCEPTtONSI ` 73-011 COUNTRY • 28910 RANCHO CLUB DR. STE F-4 CALIFORNIA RD. I , PALM DESERT CA. STE 206 LANDSCAPE ANDjTRNITURE - 92260 TEMECULA CA: ' 92590 _ c: ARE SHOWN FOR -ILLUSTRATION (760)346-4032 0)676 -SWIM ` - _, ONLY AND ARkNOT INCLUDED. - L 741 �