RPL (9910-078)LICENSED CONTRACTOR DECLARATION
i I Hereby affirm under penalty of perury'that :I am licensed under'proJisions 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
37, 27 r
bDate f� /qFgnature of Contractor"`~r' ' ^M
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.
6�M A"4-1`1 Tl.Vt°, - 111K f'f�'C,IAl1�if4"LII
.l.S_ t 1d C. I.' {.134(..7 Sr• I V' �d ' IJ ltl! t +.,nt
(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 prov,slons of Section 3700 of the Labor
Cdde, I,shall-forthwittj comply'with those >rovisions�^
(jf7te: />•i�/�-"./55✓AppIicant
a�r--j •r , l �r.�t t,a...�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued. as a result of this application becomes null and void if
work is not commenced within 180 days from. date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
Corrrect. I agree to comply with all City, and State laws relating to the building
(.9 struction, and hereby authori a representatives of this City to enter upon
/the above-mentioned property fo.r�inspection
Signature (Owner/Agent + • Date
` BUILDING PERMIT PERM'T,,7b
DATE j VALUATION LOT TRACT
f S►,:�A�H?:�id9 I
JOB SITE ( t
APN
ADDRESS., g �r p�y `4
OWNER
CONTRACTOR / DESIGNER / ENGINEER
'fir ltlf': i�iii.•'�'n�ifJ(�T� _
y
C i`f�7A!r T4t'�g?6a'f�'t•�, �?£"�i.T iiC'"i, +1.�.�f��'F±�'�
.J r Y a., e.r •. v / .,. t
90.310 i� %� ;iv
7 i i"i)ilt�J'jRXC.'s.r31�.a��., �ti►� -4
LA. Qkl.1911 -A. 42A 92133
PAIM D.H.SFACr CA 92260
(7(st1)' 46-4042 (141,# 1044
USE OF PERMIT
OWL Al+lJJe4_k SPA
SPA ONLY "..a:fALf. lois IN F{;Ai,fii i1T t
VKP,-Nl.. A:sfTt1( I N81{.0_3*1014 r
tG'fity #-WWI 'l.drrl.t tf�%'i.f�S*i W0.'VYtj-tr1ft.Y:
' Wal -#-WWI
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P1:.AMI 6 x'`9' E,, S'1sAfMA€$`fr`
PLAN VtvE "..fti P'W tU1-Ui)0-+1:3f1��tii $:•;f.+a.'�
rr)w�wRfv-p frw w. IR ito
&0aS 1VQ41(°r't,1, Tt:E4 . POOL 1111 OW4211 000 21.00
1rLEcI'RP `iii. FFr -- K01,1flI et?f3-Q2f) 0(?(? �e3.t1C�
P1,t)Mk1iN1! 47!F -- KAJI. 1101400-44q-000 $Zf.tftl
S3114.1y)`V 11.(`C1WS'rR("10N AAIgq4)+ (���f��v,alygi�yy$yyC.14F(i`'.trK,�
SPI
rr �pE �L,,
• .1w1' SS 11PI-113ltd�f.! (tl:..fa/7
b'0l'A&, i1r1R r lff 9'rL8 1,11149 NOW
$6,".7$
f�C'ZR
RECEIPT
DATE
BY
DATE FINALED
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
14
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:
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)
": ( ONTRACTOR cannot assume res on ibili y for GENERAL SPECIFICATIONS
�i �,V OlJl : '� '� OUR-
damage to orbs, sidewalks, drivewaYsl m n. SIZE 31-
r1. t ..� 18 X
+• t -; t 1 irnna AREA
• .' ry w , :� 470 PERIMETER 95
_ M= walls, sorinkler�, telephone lines or shrubs.
CRESTA BOULDERS
4" y , ' _• '' • i .;� ' NOT TO EXCEED 24" s. 0F. FE05
is made through a neighbor's DEPTH 3X5
_ a RE-INSPEIyTIDN FEE PPRO� t s understood owner. TILE CHOICE GROUP4
,. » . A IF THE A RBB.10'@+18•" 70
R7'-6" "WILL BE CHARGE CARD ARE Nig
COPING CANTILEVER
• /L ,: 5 o PLANS AND J0 A SCHEDU
signature P I 13,800 L
t - F� c F. i THE SITE FOR PUMP CAPACITY 103 GPM
18'3" Y .. k INSPECTION. X. NS! : �+ MOTOR HP STA RITE. 2 "
t r FREEFORM NO E �P
TAN ARIZONA FLAGSTONE 1 `~ `� t MOTI,RR Ir
i ' R 11 ti .: FILTER STA RETE 300 SQ FT
if DECK •r, \ 3 �s r .,, 102 GPM.
FILTER RA E SPA @ +18"
`9 l
HEATER tAa I apo B
5, �'•'`' . rr. TURNOVER 2 HRS
`=17'-3R ,f ,,. �k SUCTION IN 2
ti , , r / 18, 9., 1 . ,:..:. ' ,� ' • , .' RETURN LINES 2
�16" ' t TAN ARIZONA
Y _ KI E DEL AMERICAN
ES
P2 FLAGSTONE FACE& CAP 1,
- r—, R9'-9" 6'-9" —► w ` rf , GASLINE BY SDC FT• 160 _
• :, / fi �� 1 .. f((q �\ , 15' ��, r �,. POOL LIGHT.400 W CLOCKJANDY
R6'- I ?x P/L t' ' AIRPIPE ELECTRICAL BY. SD 250
E AUTO CLEANER GREAT WHITE
iV • D • WATERBRITE
30'' • '� R51-0". SPA SIDES •4.,Y s PLASTER COLOR PEBBLE CLR TBS
319" f��, 1260'
r 18' 2 1 �-9" - DE K BY SDC SQ
-71 DECK TYPE SLT FNSH CLR TBS
' y 6,�" I ,13 " 18'-9 " FREEFORM- STEP FT.
SPA SPECS.
SIZE 7 RAISED YES +18" w
Dining Room y = LITE 100 WATTS
RI LEVEL SEATS 22" 24" 27"
. DESIGNER DAMWALL' STACKED -
' DAMWALL TOP U RTZITE"
` •. • - . '' • ' • Kitchen "�° � .
.h JOHN/EV SPILLWAY SIZE. "X WIDE
` RS 6 GAS STUB BY SDC DATESPILLWAY XX E
G/E #JETS 4 UPER LOWER
BBQ BY -OWNER.. .6-2-99
y Lmn,- `Room •_ z . ,,
Name* STEVEN WALKER/ DR JOHN BILLESDON
4
STACKED WATERFALL DR MIKE GREEN
- W /ROCKY MOUNTAIN QUARTZ _ b o 2316" Address. 80-310 MERION .
' & o FOR cre _ -
• 'WATERLINE - r .: ': •� _
SLK.. LA QUINTA y
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:SPA DAM
FOR CONSTRUCTION PALM DESERT -
s,:--TEMECULA
• .%s::�-<�� WALL
N 73-011 COUNTRY
>:�'�z=< rl>N, ..z>;:�,.; ,..:;•: <z;y 28910 RANCHO
•,:.�.,,-;,;>- e`i r� � .';fir;;:;:, <:: •;—
,.R:..:.-""%`iti..ry .ice � :r•
_,.,k .',>n:,;: < DATE 0 Z CLUB DR. STE F-4 CALIFORNIA RD.
r> , BY
^.._ r _ r
' — PALM DESERT CA. STE 206TEMCA.
:r'
NOTE: LANDSCAPE AND FURNITURE 92260 92590
ARE SHOWN FOR ILLUSTRATION (760) 346-4032 '
(909)676 -SWIM .
;� - ONLY AND ARE NOT INCLUDED.# -571127-