RPL (9911-195)LICENSED CONTRACTOR DECLARATION
I hereby a:;irm 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 Qode, and*ny License is.in full force and effect.
License # Lic. Class Exp. Date
C-53 L? 13112 )t
yDate%T - f�`jSignature of Contractor r
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:
Carver Policy No.
g,RO ".[t.IM C_ONIP 1'a;; Policy
t1'9
(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 comply with those provisions.
,,Date: Applicant
Warning: to secure Workers' Compensation ensation covera a is unlawful and
9• P 9
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 Ouinta, 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 inspection purposes.
vSlgnature (Owner/Agent) t. f Date—' T` i1`J
BUILDING PERMIT PE9911-1191's
DATE 1'2J).()/1!X)VALUATION °a , ,Qy; .(%i�J LOT 3� TRACT
JOB SITE 43-581. ii E!,al.�li✓NA. COURT
APN - -
ADDRESS
OWNER
DESIGNER IENGINEER
(} a }�CONTRACTOR
1,0014'R Si JETr/Iwf,`iiJT.tJ ASSOC.k�''UV
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VTs C�+...�f�i. t1��1 F"�l A�\i.,ll
73613 NAPLES i.)RN11
Z
9522 DONALDSc N ROM-)
LAQt1INIA CA 92153
LUC,`FRN VA.LLLY CA 9235o
USE OF PERMIT
f}WI, Fl1+tLiJt }!t ti.S?fit.
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T%O(j.L ikNi) SPA ONLY.- .. SHALL ask: N E''L�� �`F. A
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fct7ns & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
P.)of 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
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
or
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:
1 \ � V
V\)N w dal
A RE -INSPECTION FEE OF $30
'VILL BE CHARGED IF THE APPROVED;
PL NS AND 10B CARD ARE NOT ONS
THE TE FOR A SCHEDULED,,
INSPECTI • .
NO - CEPTIONS!
`TACATION POOLS & SPAS
9522 Donaldson Road
Lucerne Valley, CA 92356
(760) 248-6045
(760) 248-2919 FAX
Lic. #C-53-351673
___�Sales Locations
Bermuda Dunes, Irvine,
California City, Rialto,
Lucerne Valley
1 800 999-1811
GENERAL SP CIFIC
�e (J' SIZE 31 x a8
L� AREA PERIMEI
L"G67
DEPTH 3
Tn P rrun1rr1= cr
Go L/-(_V'a
P0,:k t o
° s4 -t 'gin
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
COPING
MOTOR HP HP
MOTOR HP HP
FILTER
FILTER
SUCTION LINES
RETURN LINES
SKIMMER MODEL
CHECK VALVE
POOL LIGHT CLOCK
ELECTRICAL BY FT.
AUTO CLEANER
CHEM.FEEDER
PLASTER COLOR
FT.
DATE t2 t BY Air I SIZE 6 ' RAISED / 8
LITE WATTS
DUAL LEVEL SEATS GS
DAMWALL
DAMWALL TOP
CONTRACTOR cannot assume responsibility for
damage to cubs, sidewalks, driveways, cement
slabs, sewers, lawns, trees, fences, retaining walls,
sprinklers, telephone lines or shrubs.
When access is made through a neighbor's property
it is understood that you, the owner, have that
neighbor's permission and assume full responsibility.
DATE
SIGNATURE
SPILLWAY SIZE 6 ''X 1,a " WIDE
DATE SPILLWAY
#JETS Li
Name: en,S�rY
Address:
City:
Lam( g
TRACT LOT# 3�
Vacation
POOL
Cors:-ucEon Wor•.
She--t
Varve LOT 39 _ Roane
Add 43-581 MESS I NA CT _ Work
,
-ity LA QUI NTA lyiap #7--LO19
-G5
_ X St.
,
?ooi size 13 X 28
Shape CUSTOM
ahae
Depth 3-5
Code
1
Eauipment
Excavation: POOL & SPA 6&12& RAISFfI SPA
2 HP PUMP
-NOTE 6" SPA SIZE
300 CART FILTER
- Plumbing: POOL & SPAS,
y
MAINT KIT -
, 4 JETS IN SPA
POLE
2 RETURNS
POOL COVER 14 X 2R
FILL LINE
SPA COVER 6 X 6
, GAS LINE
j
steel: POOL & SPA 6&12&18" RAISED SPA PER PLAN
cun�ite:P00L & SPA 6&12&18" RAISED SPA PER PLA
SSI T I MFR 1AI /RFMQTF
22 & 24 SPA BENCH
Tile: GROUP 11 OR III
TILE/TRIM TO MATCH
— -
CeoinJ:
so-&-al Note5:
Electrical: POOL & SPA
Decks: BY OWNER
WHITE, CA, CP, EYEBALL, 2 L I TES'
Stm. Up:
Final Cleanup: