0109-220 (RPL)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
P..[oit4onals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
5714)271 AC53,,XSC.' , , '1/03
Date =? . by i 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 unddr Section B&P.C. forthis^reason
Date ,%.,e Signature of Owner�o
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.
(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 shalt forthwith comply with those"jird"v"ision_ s.
Date: �' > s7 1,, Applicant
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.n(: 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.
Signature (Owner/Agent) "} fe Date
�41//;,/
BUILDING PERMIT PERMIT#
DATE VALUATION LOT +, TRACT
JOB SITE
ADDRESS
APN
'76-845 W'ORMNOWAR COUiIT
-
OWNER
CONTRACTOR / DESIGNER / EN (NEER
ROl+a'�LYWf BERNM
MIME D01)9C39 COW, RJCMON INC.
W4-845 IMORiONGrsiLtMCti?t%f4T
7;3011CO'U9. 1plyCLUBDR,I�1nllf.,F101
LA 0,1 TI P, (,A 32253
PALM 1=141 1 CA 92260
C611�)346-41332 MIX 104.4
USE OF PERMIT
POOL ANDIOR SPA
.VA00?./SPA- e'<t,PXMSIB,f¢sRRIERS SNALi. FLS, IN Pt-4l.CL A`;Y' P.RE I?IASTP I
rNSPECT, 10W
F OOL ANMR S11 A 1.0
261700-00
1�`.�•BUNITME
P44N CHECK kTIF 101-000.433-31 €s sD .25
C°°014v;TRUC IGH FUE 101-000-418.000 $763.00
dr�3l��tAA;r D�3{I�3 — F1ty~�ttT L 101-000,421
pit,
j}�p.000 �$2{44.lf�0
I' MEL •vTIR1 M, Y•L.?• — POOL L 1 V 1. -00 J-420-000 145.08
'
P;Lumvva Fa1,00!. 101 -000 -419 -WO 00
SEP 27 2001
CITY OF LA QUINTA
FI-`�c3k+Fx'�"'I i�3�� 14�dt�?krr��y1.r?�¢¢1���Qa��f�w.p�CYqiyy���.
rrrr���`�ry
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,13ry:J
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 Wail 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
0. K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
Pool Cover
Encapsulation
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)
CONTRACTOR cannot assume responsibility for damage to GENERAL SPECIFICATIONS
curbs sidewalks driyewus cement slabs sewers. lawns.trees.
feces retaining walls sprinklers. telephone lines or shrubs. SIZE 13 - X'
32 "
LAYOUT- DESIGN & ELEVATION APPROVED. AREA 344, PERIMETER 87
BY OWNER OR OWNER'S AGENT: DEPTH 3'.-5'
• TILE CHOICE F-OCEAN Sq. 66 `
DATE RBB. SPA @+18" /REAR POOL @+6"
signature COPING ,CANTILEVER
POOL CAPACITY 12,000 .GALS
PUMP CAPACITY" 102 GPM
LA QUIYTA HOMES
MUDSILL CROSSECTION PUMP #1 STA RITE - HP. 1.5
10
1
RITE 0
TAR E 30 FT
S S
H
OUSE Q
WALY. FILTER
SPA DAM jj
'i
LEAVE DIRT FOR R
TE 1 2
FILTER RA 0 PM
....::.:....
MUD SILL
F G
SFrPERAT
E.
REAS
-RAISEDA \•
.. 00
4
T
RITE SIZE
BTU
:RET:LIItN
DECK
HEATER STA S
\
W I L
2" BE
LO MUDS L
®® � HRS
�7
•� R 4
TURNOVER VE
LIN
E VVI.TH
- J
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3
2' o"
INE
.2
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SUCTION NL S
CHECK... A).V
C
- RN LINES 2
OF
—RETURN
STRIP FORMS.FOR FINISH - P/`-. 5''8" - BUILDING'& A 01 _ `S'KIMMER MODEL AMERICAN `
I, STUCCO TO MATCH HOUSE SEAQ - SAFE7 y , FIECK VALVE YES
FREESTANDING 4 ASL`INE BY SDC FT. 140
DOUBLE CANTILEVER CAP 6-0 P/A +6' PATIO ARBOR .D v OOL'UGHT 400 W CLOCK T104_
`� BY HUTH AWNING N TR
l J\ 1 r 13'-0" Y QUART ITE- VCTI KECTRICAL BY.- SDC FT. 300
X18" �� 3 27-2" Oq E of .,
' t EEDER
O AIR INDUCTION PIPE \ 25-6 .. �� 6Y
,1a'-o' ER COLOR PEBL CARIB. BLUE
191-2 4•` \ � � �/ � ,�'(�/ ' ! ' - �.. DECK BY SDC SQ. • 1440
_ �• \ \- //j/ .�t% DECK TYPE SALT -SD BUFF
RY ow
N1 1g'6 , • 8,-0.. Tyq S yygf?G, �� SPA SPECS.
16.-0 -� _ _ F_.S/ DJCe TC p - ..: SIZE 7' RAISED +18"-''
32'-9" / 7 -4 �N
v _ 15'-3" SLEEVE ALL SpFCT % FCR CgRpq '��, �x�NDYirr LITE 100 WATTS „
��> PATIO COVER - R5'-10' - /� R�
BY HUTH AWNI PLANTER AREAS . �Q S+C /�/ r IAT.E:::::: TRI LEVEL SEATS 22 24 27
- 9-0. - - ,'. yFQ /I` DAMWALL 18 " X 8. FT.
EQUIPMENT WALL G'£p /44101 DAMWALL TOP QUARTZITE GOLD
42" HIGH x 14' LONG . %/C + r
P/A R�d,tat+f ` / , BLOCK TO MATCH P/ L /vs! _ :#2 VTSEf?:: SPILLWAY SIZE T WIDE
-------- :'.:).` SPILLWAY XX OPEN CLOSED .
5'-3`' - — moo3l � o9;12ro1 #JETS 4 UPPER LOWER
LIGHT SWITCH 79721ti1� - E rn , : >. 1c - r� , . _ • . - BERNIER; RON & .LYNN
0015 #4 20'-11" .Name:. •
mao�i 1 s�� R Address: 78845 MORNINGSTAR CT.' -k
• G/E _ = �, = a . . LA UINTA
1 q
TRACT STARLIGHT DUNES LOT# 56 `'. �, `r
• - � , _, : oma. • • �,. � _ ti 4 !• c®P�( _ .• �..
P/ r.9d?z;?! s , • S� ,'`` aA3�CFT 'cy . - r '•' r
JIM
o6onl.
tsi-]Ilwq ` tM r • "Y LAWN _
t°� =STORAGE - - - - - AREA `h;
ROOM,nrrtQ . ;.
PALM DESERT TEMECULA
' ::• ��� : « N
73-011 COUNTRY CLUB DR. 28910 RANCHO
. .- -•• BOBCAT -
IIIF— �.. -----_ ___ " �, surrE F 4 _ - CALIFORNIA RD. SUITE 203'
'r'- ,¢ 1 _ PALM DESERT CA. 92260 TE
MECULA CA. 92590
- - - - ACCESS PAGE•1OF•2 ,
re ` �., 909 676-7946
,!!]] EE I -f�7b$ �. _ 9;'• R& R ;(760) 346-4032 ( )
'•il�fl r ' y `mac -
: LIC # A-C53-HIC-574127