RPL (0006-360)F
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
Profession Js Code, and my License is in full force and effect.
License #Lic. Class Exp. Date
574,127 ` I
Date Signature of Coritractor
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).
O 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 13TATg FUND Policy No. 046.00.0047934
(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 h f with comply witFI����h��pse_ provisions.
Date: � � d® Applicant /' L 7+ 7- a,+�:
Warning: Failure to secure Worers' 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 above-mentioned property for inspection purposes. r
Signature (Owner/Agent)f'�''-`Lf�''�' ��1�' Date!��
Vd 6l; UILDING PERMIT PERMIT#
DATE VALUATION LOT (M6-&iiO TRACT
�-+
/dtiE 940, fi ,00
JOB SITE
ADDRESS
APN
rtia(
49-6201147 ' OM MW WTST
1 ..
OWNER
CONTRACTOR / DESIGNER / EN INEER
GUMS & I.INDA.•V 91JAW
TIEVE DWS014 CON"EMUCROMWC.
49.6201�0."310 Y DPM WEEST
7.011 COUN'!RY C3LUF3 D11, BUY1e4
LACUINTA CA 92253
PALM D.. WR -T CA 92260
(760)346-4032 MA 1044
USE OF PERMIT
POOL AND/01Z SPA ,v
POOL & SPA ONLY=A%,E3RMStBARRIER,S SHALL BE IN ALACP AT PRE
PLASTER INSPECTION, POO1, EQUIPMEN'±' ENCLOSURE IS NOT INC .LUDEP
M THIS PEP.• I
POOL AN DIOR SPA 40,000,00 LS
FZI TAA'.iM C -09.r OF CO.NS'MUC7 ION
40,000>00
I<''".�Z3hZf X1 J?E SVWIARY
PIAN CHECK PUE 101-000-439r318 $227;1 u
CONS T RUCTION FEE 101-000=418-000 $349.50
MECHANICAL RE -- POOL. 101.000.421.000 $24,00
LLECTMCAl. FEF — POOL 101-00"20-000 $43.00
PLUMBING FEE -- POOL 101.000-419.000 $27,00
't. £...t
.g
�
MM -TOTAL C:OKS=L'R't MON AND PLAN CSC.:
$612.68
LAS PRE-PA113 P.IaW
MOD
ff)TA-L 1PhIMM M ]DUF1 PiOW
S67201
RECEIPT
DATE
Y
�>
DATE FINALED
INS;
3 -a
�.rI <L".
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set aacks
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
Set Backs
Steel
Electric Bond
POOLS - SPAS
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
�_
Underground Plbg. Test
rt
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
Q y
Gas Piping
Gas Test
'Appliances
Final
T 25a
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:
+24"
+18"
GOLF COURSE
6'-6"
+24" FREE FORM .
+12" RBB
+12n
8'-6"
RIO' -0"
t
-9t
AIRPIPE
PAL
STUCCO BLOCK
EQUIPMENT
WALL BY SDC'
7t-0"
W
TANNING LEDGE
I,
tt
15t6 '
t
S
43"
k IF-
1 37'
32'-
21' 25'-9"
I REMOVE 290
I OFXISTING
CONCRETE I
1 -
OWNE9TO SELECT B0,1ULDERS
NOT TO EXCEED 36"
i
— R6 -0 r
1
a
t "
21 -0
BENCH
I
\ 4
39 "
K,I
l/
1 I }.
OUILDING & SAFETY
�- AQUA SWITCH APPROVED
FOR CONSTRUCTION
RESIDEN E�j,�
By
LA QUINTA HOMES
MUDSILL CROSSECTII
HOUSE
MUD SILL
%ECIK
2" BELOW MUDSH.L
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE 'SITE FOR A SCHEDULER
INSPECTION.
SRO UCEp°rIONS! .
j�
i
CONTRACTOR cannot assume responsibility for GENERAL SPECIFICATIONS
damage to curbs. sidewalks, driveways, cementSIZE 18 X 31
slabs. sewers. lawns,trees, fences. r ainina
waAREA 396 PERIMETER 88
walls, sprinklers- telephone lines or shrubc_
When access is made through a neighbor's DEPTH 3X5
property it is understood that yam, the owner, TILE CHOICE GROUP 3 SQ, 122
have that neighbor's permission and assume full 28'@+12" 10'@+18"11'@+24".
responsibility. COPING CANTILEVER
DATE � signature POOL CAPACITY 11,886 GALS
PUMP CAPACITY 103 GPM
ttACKFD WATFRFAL
- W /ROCKY MOUNTAIN QUARTZ
' WATERLINE 6 CAP FOR CASCADE
.
MOT
.Ines
::^::£s% i • z::z$:::y, :: ;.:e i::i::#i4i>E::.y:*? i3`
IN'TOP OF DAM
TURNOVER.' 2 HRS
WALL
RET U RN LINES 2 11
SKIMMER M DE' AMERICAN
CHECK VALVE YES
GASLINE BY SDC FT. ALL
POOL LIGHT 400 W CLOCK AQUA
WA TERLnvE
<:
.a^
s
>:.
.18 WIDE
:SPA DAM
xis>r+:f
}
WALL
<'t<
.sEP'
ER;4'TE:
>>
:Q3ECK:YAi...E
r%ya
ELECTRICAL BY. SDC PT ALL
AUTO CL
BBQ BY SDC PLASTER COLOR PEBBLE TBS
GAS STUB BY SDC
GFIOUTLET In IDECK BY SDC SQ. 1572
DECK TYPESLT FNSH COLOR TBS
STEP FT.
SPA SPECS.
DESIGNER SIZE 7 RAISED+18"
LITE 100 =" WATTS
WATERFALL CROSSECTION (no
RANDY/EV RI LEVEL SEATS 22" 24" 27"
SC81@) upbasin DATE DAMWALL STACKED
DAMWALL TOP QUARTZITE
lower ..``, T 425-00 SPILLWAY SIZE 6' WIDE
basin T REVISED SPILLWAY XX OPEN CLOSED
' # JETS 4 UPER 1 LOWER
............ �..a CHRISILINDA
!de WILLIAMS RESIDENCE
pool water Address: 49-620 MISSION DRIVE WEST
4'-0" QdY[ LA QUINTA
TRACT RANCHO LA LOT# 17
OrM -ma QUINTA
36"
SCORELINE DO soft
PATTERN
ALL DECK
POO/S
TYPICAL
PALM DESERT TEMECULA
N 73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
1/8"=1' SCALEPALM DESERT CA. STE 206Y
NOTE: LANDSCAPE AND FURNITURE 92260 TE
MECULA CA.
92
ARE SHOWN FOR ILLUSTRATION (760)346-4032
92590
ONLY AND ARE NOT INCLUDED. (909)676 -SWIM
�r
MOTOR HP STA RITE HP 1.5
MOT
FILTER STA RITE 300 SQ FT
FILTER RATE 102 GPM
STA -RITE HEATER 400 BTU
TURNOVER.' 2 HRS
SUCTION IN 2 11
RET U RN LINES 2 11
SKIMMER M DE' AMERICAN
CHECK VALVE YES
GASLINE BY SDC FT. ALL
POOL LIGHT 400 W CLOCK AQUA
ELECTRICAL BY. SDC PT ALL
AUTO CL
BBQ BY SDC PLASTER COLOR PEBBLE TBS
GAS STUB BY SDC
GFIOUTLET In IDECK BY SDC SQ. 1572
DECK TYPESLT FNSH COLOR TBS
STEP FT.
SPA SPECS.
DESIGNER SIZE 7 RAISED+18"
LITE 100 =" WATTS
WATERFALL CROSSECTION (no
RANDY/EV RI LEVEL SEATS 22" 24" 27"
SC81@) upbasin DATE DAMWALL STACKED
DAMWALL TOP QUARTZITE
lower ..``, T 425-00 SPILLWAY SIZE 6' WIDE
basin T REVISED SPILLWAY XX OPEN CLOSED
' # JETS 4 UPER 1 LOWER
............ �..a CHRISILINDA
!de WILLIAMS RESIDENCE
pool water Address: 49-620 MISSION DRIVE WEST
4'-0" QdY[ LA QUINTA
TRACT RANCHO LA LOT# 17
OrM -ma QUINTA
36"
SCORELINE DO soft
PATTERN
ALL DECK
POO/S
TYPICAL
PALM DESERT TEMECULA
N 73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
1/8"=1' SCALEPALM DESERT CA. STE 206Y
NOTE: LANDSCAPE AND FURNITURE 92260 TE
MECULA CA.
92
ARE SHOWN FOR ILLUSTRATION (760)346-4032
92590
ONLY AND ARE NOT INCLUDED. (909)676 -SWIM
�r