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RPL (9911-153)LICENSED CONTRACTOR DECLARATION 1 -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 574127 '.r� .a:_ . __ 08/31120i °©ate S 1- 23. Signature of Contractor— 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 3700of the Labor Code, for the performance of the work for which this permit is issued. ( 1, 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 `1TA.Tl;rsl:'1vD Policy No. 0W91111000192I (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 Sectiorf 3700 of the'Labor Code, I shall forthwith comply -with those provisions: Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for -a permit subject to the conditions and restrictions set forth. on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any,permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will 'subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the abgve-mentioned propertyfor inspection purposes. n - ,Signature (Owner/Agent)-- y w Date BUILDING PERMIT PERMIT# DATE I I M3119 VALUATION �.�.�Q�SI,��I LOT TRACT JOB SITE ADDRESS M324 Ii ERIOIN APN OWNER CONTRACTOR/DESIGNER/ENGINEER tywrrara:*� r�r4r vP r. c���*�r;r c'r'�rar DC :�e)t.r t,ghiS,ruxsr- t�>� { i.. d 4_.,t 4u,P'.trif. [vl dAl. IC ..}� L'1 .(� \ {, V &^a\ 14 R,,-11 v�., A. R�\I\o 1 JiY 77161 M, -.JL -"f A AVE. 71011 COL'i+f'IR Y" Ci,US DR., S1 TrE F4 CA 91504 PALM S:DtaSI%IRT CA 92260 (76()W-41112 (191.,11 10,313 USE OF PERMIT V(.A)1, AN1)/4J t ;"SVA V(_)0L .iV4,t; :9i'FL. QP11. PL,AS11A 1N8Pis _'fly N, POOL AidlXOR PA �),�yfkfofifr ,T,f; 7r� 'ys��,.y �• f; t, Y ��L b e :3JA: iI:o :f�".fs ' 'It.$') mStr Of' CONSTRIXRON PLAN C BECK YEE (70WS1'RTV 'Pf0N 1%FF ;1A 1401- 411j;..'017K) "A 1XIE 11AN1i;"M, FEE t POOL 111}. U* 121 11" X7,8 ;� IE. 0J'R1�'Ai.1 rii; •,- T't31))» PL.UMf~1lN01'F 3'C1f31 7,1t1 (f(ft1-11's�-434DU:'`7,tTie RECEIPT AN.D II -AN VII6?CK LESS M2,1PAID FEES 1 0`1'? L P.E '!1l'$ I+ C&S IN; N NOW DATE FINALED I INSPECTOR ,4irS 4:i 00 $56543 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 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) CITY OF LA QUINTA .BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION y ry CONTRACTOR cannot assume responsibility for GENERAL SPECIFICATIONS damage to curbs, sidewalks, driveways, m n SIZE 1616" X 28'6" slabs, sewers, lawn ,trees, fences,retains►+' AREA 335 PERIMETER 80 walls, sprinklers, telephone lines or shrubs. When access is made through a neighbor's DEPTH3X5 property it is understood that you, the owner. TILE CHOICE GROUP 3 SQ, 92 have that neighbor's permission and assume full RBB, 32'Q+12" 9'Q+18" ' responsibility. COPING CANTILEVER I J�gq I - DATE signature POOL CAPACITY10,005GALS �P/L DATE I ,� PUMP CAPACITY 10'3 GPM MOTOR HP STA grrF Hp 1.5 TWO 18"CUSTOM CASCADES ' 6-6.. 18" SHEET FLOW SPILL T i • UNDER CANTILEVER CAP _\ R6'-9" I' R5'-3". MOTOR HP HP FILTER STA RITE 300 SQ FT FILTER TE 1()2 GPM -HEATER LAARS SIZE 400 BT TURNOVER 2 HRS LINESSUCTION 2 it RETURN LINES 2 SKIMMER MODEL AMERICAN CHECK VALVE YES GASLINE BY SDC FT, 126 POOL LIGHT 400 W CLOCK . 1, t ��(�"-_�_._r_ •�, 4, ��` � � - ELECTRICAL BY. SDC 300 _w 5 AUTO CLEANER GREAT WHITE A• +18' RE -INSPECTION 1FEE OF $30 H F EDE .14'-60 9'-6 " :WILL BE CHARGED: IF THE APPROVED PLASTER COLOR WHITE k k AI PIANS. AND JOB CARD. ARE NOT ON DE K BY SDC $Q, 1417 RPIPE THE -SITE FOR A SCHEDULED DECK TYPE SLT FNSH SD BUFF 8 s '7_ STEP R6' -C) 4` I k - ON. �' P/L� A" - - . _ _ NO EXCEPTIONSt SPA SPECS: TANNING LEDGE '-P/A - ' -°� 29� 9" ..:., ::.., t: SIZE • 7 RAISED YES +18" LITE 100 WATTS 34�" B CI I RI LEVEL SEATS 22" 24' 27" � ----=------ 13'-4." 1 DESIGNER DAMWALL 18 " X 6 FT. — ` — — — — �, - — — — — DALL PMWWODECK I JOHN/EV AY SIZE X 18" WIDE 231-3� DATE SPILLWAY OPEN XX CLOSED 1 136" ' •13�� ����Yl� BBQ BY OWNER SDS 36 P/L # JETS 4 UPER LOWER G/E STUBS BY SDC 11-3-99 Name:SATi Y�IV l�A �L - ...... .. .. .. ` .. • ti>�' . Address: 80-324 MERION �J3X�LA QUINTA $� STUCCO BLOK 4' HIGH NGWALLS TRACT RYDER LQIfA - I� < HOE ACC S .&R jl J. G/E 1 �,r •, �M� f'•� CPi. T PALM DESERT TEMECULA - N 73-011 COUNTRY 28910 RANCHO _ CLUB DR. STE F-4 CALIFORNIA RD. PALM DESERT CA. STE 206 • '• • • • • NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA. ' . •_ 92590 ARE SHOWN FOR ILLUSTRATION (760) 346-4032 (909)676 -SWIM ONLY AND ARE NOT INCLUDED. LIC# A- 574127