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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
.Profess;•onals Code, and my License_ is in full force and effect.
r"',ti "License # Lic. Class, -_--.--Ex. p.Date
57412? lei J'� �USf31/2G
Date 'a '� / Signature,of Contractors-''�—
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:
CarrierPolicy No.
2•r,�.TS 1fvrll�y 046.00.00"934
(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"th,Vf I should become
subject to the workers' compensation provislo�ns''of Section 3700 of the Labor
/Code, I all forthwith comply with those provisions
Date:;' Li' L0 Applicant . ✓T'r�.'��}(.�' r �. a_.• ,...... 4+
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
i the above-mentioned property on
for inspectl`purposes.
17
Signature (Owner/Agent)A % .' i Date 4;-
BUILDING PERMIT PERMIT#
- r
016-Q.�
'TATE
VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 43-6AGM-14 C•OVIff
OWNER-
CONTRACTOR/DESIGNER/EN (NEER
OREG- HMSON'
STLM DODSON COIdS'i12.iiM1014 ,0TC.
4Z-605 V-n.W COURT
71011 COUNTRY CLUB Dr.,, 3=114
LA QUVY1 A CA 92253
PA.F..M DRSEIZ71 CA ' 92260
(760)346-4032 C3Toft 1044
USE OF PERMIT
POOL AND/OR SQA
POOL & SPA ONLY- ALA RMSWA RRIF.ItS SHA.L , UE IN PLA.CZ AT f
Pft&PLA3Tl,.R iNSPECTIOM HIS PERMIT DOES NOT INt'UIDE BLOM,
WALL FOR EQUIPTa4"T.04CLOSURL
VALUATION 2I.i'Q0XI) LD
Eaa'X7AUKIR" cost Chi+: CONYMU'C.HON
, 2t,000.00 .
PE10ATFEE WAMARY
PLAN CI• er,1ET 201.000-439-318 $140.40
CONSTRUC:TION FEE 101-000.41$I'-000 $216.00
MECHANICAL YEE -- POOL, 1 Q1 �000- I21 -00o 3113.00
«w
ELECTRICAL F'1 Z -a POLL 101-000-420-000 $45..00
PLUMBIN0IEW. -POOL 101.000-419.600. $27.00
•
r��� orf
V.,>
SUP- OTAL CONEURUCTION AM,PT". C. .,C.K
$1452.40
1E9 PIV"PATD iTM
$0-,00 '
TOTAL. 4PgSSKU3SVLd71.e'!C ':
t9'l�idrA9
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 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
Bond Beam
Main Drain
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)
W /ROCKY MOUNTAIN OI Al R7Z F
wATPau nvE cAp FOR cAscaDE �_ �° ; t' , CONTRACTOR cannot assume res on ibili y for GENERAL SPECIFICATIONS
, damage to curbs, sidewalks, driveways,cement
SIZE 14 X 3' 6" -
.♦1VTOPOFDAM - •�. - '3
4 ZY ::'/,t.'R?�, :�%{ :::x:,. WALL _ • slabs, sewers- awns,trees,• fence_, r aid6na
.: f' - REVISION ALERT-_
>n" walls sprinklers telephone lines or shrubs AREA 408 PERIMETER 92
,•'r> JF:'?s�>'" 3` z?%rn :'yY.r TAP: ' - 1 i 1 n
ra<•:a:: r<<'a` .Y,,. LOCATE POOL
) When access is made through a neighbor's DEPTH 31611
-GREEN iZ a jitsunderstood thTILE CHOICE F
WATERUNE
>«�`a have that nei hbor s ermfission
and ac-
ume full RBB. +
t
i
CANTILEVER
ERresponsibility, COPING
<:.
DATE
1
2440
P
,,. signat re L A
18
WID
E
GALS
PUMP CAPACITY
APA ITY
03
GPM
r rr
r
SPA DAM _
•': MOTOR HP
1
.5
3 -6
TA RITE
m
aster
• f' HP
:WALLr:
r.
1
_ h Mo T
...........
P
............:::
1 nook
FILTER
><.:r S FT
, bedroom ��;. T
1
OO RITE Q
I
i
•
102
GPM
P/L
i
•� " °.f HE RLAAR 400
f .I •+ ' _ t, TURNOVER 2 HRS
SUCTION INE 1/
4
RETURN LINES 2
AQUASWITCH (. . i KI M D CHECK VALVE
ESERICAN 11
EXACT LOCATION -J,-,.,,, � .
baCK at +6.1
1 TO BE DETERMINED ' GASLINE BY SDC FT. 70
_ POOL LIGHT400 W CLOCK AQUA 1
9' r ELECTRICAL BY. SDC '250
— 171-3" - `RESIDENCE _ j s.." AUTO
` ~.. BENCH y•.. rCHEM.
ry. y PLASTER COLOR WHITE
11' ' g,_�;' r D B SDC SQ. 1032
PALM SPRINGS ' h' ` ' - DECK TYPLSLT FNSH OMAHA TAN
GOLD BOULDERS . 1 2 62 �SF` ADDITIONAL DECK k '
_\ 1 .. •' "' - . • STEP FT.
NOT TO EXCEED 36" SPA SPECS. _ -- a ' � �. -
P/L \ 1 ! DESIGNER SIZE 7 .. RAISED +18"
30'-311
* 21'-611 r
30'-3 "
3 — 1 GARAGE°
311. ,
G/E I
S'-6"
LITE 100 WATTS
RANDY/EV TRI LEVEL SEATS 22" 24" 27"
DATE DAMWALL STACKED
2-29-00 DAMWALL TOP QUARTZITE
SPILLWAY SIZE --I*WIDE
REVISED SPILLWAY XX OPEN CLOSED
6-15-00 # JETS 4 UPER LOWER
Name GREG HESSON
Address: 43-605• MILAN' COURT'
cay
LA QUINTA `
1 N
'1 _ , TRACT BELLA VISTA LQlA 30
ITY OF LA QUINTA .``
C =
BUILDING & SAFETY DEPT.
APPROVE,.
r ADD VE NT s' FOR CONSTRUCTION is
.
STACK o f T I PALM DESERT TEMECULA _ui BY
°t
!.
TO HEATER a o' - -
•
• j ECALIFORNIA J. .-- ATE "— ' N 73 011 COUNTRY 28910 RANCH
'1/8 —1 SCALE CLUB DR. ST F-4 CAUFORN RD
PALM DESERT CA. STE 206
5' . BACKHOE ACCE S NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA'
�: NO R&R t - - 92590 �.. . .
.,r `ARE SHOWN FOR ILLUSTRATION (760) 346 4032 '.(909)676 -SWIM r z
ONLY AND ARE NOT •yE'
INCLUDED.' A-574127
CONTRACTOR cannot assume res on ibili y for • GENERAL SPECIFICATIONS
damage si sdriveways ce e t
+u"TOP OF DAM ama a to curbspdewalk, m n SIZE
14 X 33'6"
�.sk4
fences, r ai$I. sewers, IaWns.t$.
- WALLa, walls, sprinklers, telephone lines or shnibc AREA 408 PERIMETER 92
T,oP: AIRPIPE
made through a nei hbor's DEPTH 31611 fro er#y if understood that you, the owner TILE CHOICE F GREEN SQ. 76
WATIItLINE ,.
have that nei hbor s permission and assume full
B. t n 0'@+l8"X.
r=;x>
resp
on
CANTILEVER
T
y"^
DA E
-- ... 1244
0
signature nature
<'
G LS
X18" WIDE
I E1
03
P CAPACITY
GPM
�.
PA _
i•
S DAM
MOTOR HP STA RITE HP
1
,r.
a.
s>'
:WALL <�;>
E
t ,
T0.
. � 0P
:R
3 6
s
.>
FILTER .. E
SQ FT
811
1iSIT & SPIN PAVE
RFINISH
SH
P
FILTER RATE 102
G M
Mr
0
-............
...................
.. � a DECK
HEATER
I
400 BTU
. • , � . � • �TURNOVER 2 HRS
i
I
SUCTION LINES 2
f
- r -r
RETURN LINES
2DECK
IF
a..
iE
NEE SKIMMER M
AMERICAN
u
9
- `'�� � • � .CHECK VALVE YES
-/ BENCH SDC
' t GU TE
GASLINE BY FT. 70
6 P'
PALM SPRINGS GOLD BOULDERS .� "'> OOL LGHT400 W CLOCK AQUA
NOT TO EXCEED 24" - N.
ELECTRICAL BY. SDC 250
_ ;t:>
.<....... AUTO ftEANER
' - 8'6"CHEM.T
4,61
r t ; PLASTER COLOR WHITE
P/L \ ,� } .• Y t DECK BY SDC SQ. 770 •
DECK TYPL
21'-6 2.SLT FNSH OMAHA TAN
�` a _ STEP FT.
_ BBQ BY OWNER , P/L` SPA SPECS.
t
f
` GAS STUB FOR BBQ 37' t DES R- SIZE 7 RAISED +18 x
BY SDC ' ,' u►� LITE 100 WATTS
3,
j
G/E
BOBCAT ACCESS
R&R BLOCKWALL .
•
130'9" IQ �. RANDY/EV TRI LEVEL SEATS 22" 24° 27"
DATE
DAMWALL STACKED
DAMWALL TOP QUARTZITE
2-29-00 . - - SPILLWAY SIZE —J WIDE
/ . .REVISEDSPILLWAY XX L
R8'-6" `� V • /�� # JETS UPER LOWER
15' C
GREG HESSON
25' - _ Addres, 43-605 MILAN COURT '.
LA QUINTA
master TRACT BELLA VISTA LOT# • 30' -
6'—p"
nook. -bedroom
S r S Do son
AQUASWITCH F o`
. . _ . , , .. �• t ��-�'`� � - Poo s
S.
- PALM DESERT TEMECULA t
-•' N 73-011 'COUNTRY 28910 RANCHO
' CLUB DR. STE F-4 CALIFORNIA RD
RESIDENCE I}� 1/8"=1' SCALE PALM DESERT CA. STE 206 �.
NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA.
4ARE SHOWN FOR ILLUSTRATION. (760) 346-4032 90 90
•' (909)676 -SWIM -
' ( .ONLY AND ARE NOT INCLUDED. LIC # A-574127
4 ' • *iATEREJNE & -AP FOR MOUNTAIN
J— f _ '
- W /ROCKY MOUNTAIN QUA ,,-' , , . , ` t GENERAL SPECIFICATIONS
CONTRACTOR cannot assume res n ibili y for y s.
' + + atti'BB } r u � f ` r damage t0 CLFbS; sidewalks,_driveways; cement
r "
M<' SIZE �14, X 33 6
,r>;:> :Ss:F z, ^„a♦t5'"fOP OF DAM ;
.,.. slabs ewers lawns'trees fences.',
<>> 3 r rretaini
WALL •.r - _-_
REVISION ALERT
RT .
PERIMETER 408
ET
ARE
A
0 _92
k ,
wall nn I� rs I phone lines o s_
� tee r hr�bs.
- _fir r
e
RELOCATE POOL x p P 31611-
M
) When access is made throw h a nei hb„ak�<��-<' _ s 9 9 ors
:�..
1 ro-
e
owner,
ze[Syitisuiderstood that youth
TILE CHOICEE
F-GREENFATERLI�E
fl have that rmission andm32'-@+6”r
r
,hfullassue
1 .
onsi T
e 'b'
r s ility.
COPING CANTILEVER
A
D TE.
1244
°> >« 0
G LS— �• PCAPACITY
......:;.:::..
si na
re
r
S
:.
18 03
WIDE
{ PUMP APA tTY
U C C
GPM
7
.F
,.. _
::::::::::::::::::SPA
SPA
DAM
eII
• ' i
32'
•
- Y
-t
•
r
f
MOTOR
0
R
31-6 HPtr tmaster STA RITE
HP 1
.5
M T P
bedroom. T RITE QnOOk IT '102 FT
P/LFILTER RAT
GPM
000
00
� . HEATER LAARS -SIzE 400 BTU
+ I 3 TURNOVER 2 HRS
I 11
y - ♦18 • I 1. ----- 7 _O I N LIN 2 „
• - _ ; - } . RETURN LINES 2 „
J li' A UASWITCH T r KIM D AMERICAN „
Q t, + YES`
rr .y I EXACT LOCATION.., `
baCK at'+6 I TO BE DETERMINE]); GASUNE BY SDC FT. 70 '
` 1 Y
POOL: LIGHT400 W CLOCK A UA
_ ELECTRICAL BY. SDC -250
t a 17'-3” ~ RESIDENCE AUTO
CHEM.
' BENCH PLASTER COLOR WHITE
i u. I til , . - .. D BY SDC SQ. .1032
`PALM SPRINGS j ` 11 - 8._5 262 SF ADDITIONAL DECK ` DECK TYPESET FNSH OMAHA TAN
' GOLD BOULDERS STEP FT.
..NOT TO EXCEED 36" r \ I - SPA SPECS. ,
_\ I DESIGNER SIZE 7'
P/L . RAISED +18"
.30'-3 It + T LITE 100 WATTS
SIT &SPIN SPA VERTICAL FINISH RANDY/EV TRI LEVEL SEATS 22" 241#- 27"
21'-6" F a r
r r DECK DATE • DAMWALL STACKED
/ r - DAMWALL TOP
t `tt 2-29 00 QUARTZITE
3
0 -3
t
PI
S LLWAY.IZE
S DE
RESED SPILLWAY
<:� VI XX D'
GARAGE-
DECK
r
#T
JE S 4 UPER LOWER
V
0 ER
I SNEER
G/E Name: ,
- GREG HESSON
. , rLJNITE
Address:' 4.3-605 MILAN COURT
r ' a Q
LA UINTA "k
-
' t TRACT BELLA VISTA LQT# 30 -
�r� Y
ADD VENT
' STACK oo q T PALM DESERT TEMECULA
TO HEATER N 73-011 COUNTRY 28910 RANCHO
$J CLUB DR: STE F-4 CALIFORNIA RD `f i
SCALE PALM DESERT CA. STE 206
5' BACKHOE 'ACCE S , NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA
' 9259.0 .3
® _ NO R&R _ ARE SHOWN FOR ILLUSTRATION Viso) 346-4032 (,909)676 -SWIM
UC
ONLY AND ARE NOT INCLUDED. #
_.