RPL (0312-032)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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date Signature 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.O. for this reason
J �j �i�,� �",,
Date 2. Signature of Owner 1,51 -MLA, At
.h L -h:c+-.-•
_iA-
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).
�X) 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: T;... i � Applicant; fir' 0.
K
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.l 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) L �� � " + c- � r� '�^Date 1'b/9
I'J ' o
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BUILDING PERMIT -PERMIT
DATE VALUATION LOT "'� TRACT
JOB SITE
ADDRESS' l,94.i., M03R M AVE VE
a•
•
OWNER
CONTRACTOR/DESIGNER/ENGINEER
:DirVZCsi; r & 1+'C9LWDA WARMON'
OihtI ER.-'iii3ftDM.
79-£31:3 M0.120-15 AttENITE
✓R'QaT�i C . CA 9,2233
USE OF PERMIT
POOL MM/OR SPA
POOLISP.A. ALAitMSIDARP.iiM S; I.ALL }5Z 1%,4 PL..& AT X3RP�PLAS' EP.
Hi 14TTON, EQUIPMENT ENT F.NCi.O1RUHu NOT t2r3Ci.,i3DED
POOLAAT4.�101: SPA. 20 00,00 W
l
' Fsr,e�'e�e �a��Yrrie�a �+to is �Sv��*s �trw� 'e7
.�a.6a�osc•�.ni.D {rO.0 s.:F �`�).aFSURU . tii IO I
u� nn
.2k..5,0M c�•.
PT , IN CHECKFEE 301-000-439-518 $163.80
C0114STRUMIJON MCI
MEC HANWAL FR:S -- POOL 101-000.4-21.000 $24,40
ELFCTR1CAL.:'BE — POOH ` 101-000420-000 $45.00
PlA to NO PFF -• TOOL 101:-000.419.000'• $27.00
1�-Tl�il�. ^t1�1 T11?trAS4 J .r,r.�K"C.`.F3rXX
-$111.80
Uss 'PRE -`PAID 'MX13
$0.00
D
lirAl. f"WIS.DUENOW
V9118 0
QUINTA
city DEPT
��7 l
RECEIPT
DATE^'yj + 1^
t J `�
BY'w
DATE FI ALED
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 Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
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:
_
OWNER / BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has, been submitted in your name listing yourself as the builder of the property
improvements specified.
Foryour protection you should be aware that as "Owner/ Builder" you are,the responsible party of record,on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself frompossible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license.
from the City or'County. They are also required by law to put their license number on all permits for which they
apply.
If you, plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the.following.information for your benefit and protection:
.If you employ or otherwise engage any persons other than your, immediate family, and the work (including'materials
and other costs) is $200.00 or more for the entire- project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are,an employer, you must register with the State and Federal Government as.an employer,and you are subject
to several obligations including.State and Federal. ;income..tax-withholding,fecleral social 'security. taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may. be financial risks for you if you do not carry out these obligations; and these risks are especially serious with
respect to worker's compensation insurance. '
For more specific information about your obligations under Federal Law, contact the"Internal Revenue Service (and, if.
you wish, the U.S. Small Business Adminstration).'For more specific information about your obligations under State.
Law, contact the- Department of Benefit Payments -and the. Division of Industrial Accidents.
If -the structure is intended.for.sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing "their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you arc aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF ILA QUINTA
DEPT: OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 92253
(760)777-7012
F b760) 777- 11
'�PER'S SIGNATURE/DATE
7911
3 ODA%. '�AQ
PROP RTY ADDRESS
PERMIT NUMBER(s)
DWIGHT AND YOLANDA HARMON
79-813 MORRIS ST.
LA QUINTA, CALIF. 92253
MONTICELLO ESTATES CENTURY HOMES
GENERAL SPECIFICATIONS
DIMENSIONS: POOL SPA
Length: 34'0" 7'0"
Width: 20'0" 7'0"
Surface Area: 527 SF 38 SF
Perimeter: 102 FT 23 FT
Depth: 3'0" to 5'042" MAX" .
Demo: I-
Concrete: v N/A
Sod / Gravel: N/A
Plumbing:
Extra Spa to Equipment: 15'
Raised Spa Bypass w/ck value: YES
Dedicated Vac Line: YES
Gas Line Extra: 25' LF
Gas Line for BBQ/Fire Pit: YES
• Spa Jets: SIX BACK JETS
Decking:
Color w/salt finish: 830 SF DECKING, CAP @ RAISED SPA
Cantilever Edge: 125 LF / SMOOTH BAND FINISH/PERIM.
3" Deck Drains (per LF):, AREA DRAINS AS NEEDED
Step Riser (per LF): N/A
Dam Wall: +f8" stacked spillway quartzite
Raised Bond Beam: 34'@+12"
Umbrella Sleeve: YES @ TANNING SHELF
Tile/Stone:
Basic Tile Group: 125 LF 6" GROUP 1 OR 2 TILE
Quartzite 6" Waterline: N/A
Step Trim: N/A o-
Tile Raised Areas: Veneer in quartzite on RBB
Masonry:
Spillway: ` 6 FT.QUARTZITE SPILLWAY
Waterfall: N/A
BBQ:, GAS STUB ONLY
Firepit: N/A
Boulders: 'VERIFY WITH OWNER
Access Wall: REMOVE AND REPLACE BLOCK WALL
Equipment Wall: 4'H X 4'W STUCCO TO MATCH
Paint/Stucco/Plaster: STUCCO SPA EXT
Pool Finish:
White Pool Plaster: N/A
Pebble Pool: PEBBLE FINISH PLASTER - TAHOE BLUE
Equipment:
Pump: HAYWARD NORTHSTAR 1.5 HP CIRC/SPA
Pump: N/A
Filter: HAYWARD 300 SF CARTRIDGE -TYPE -
Heater: HAYWARD 400k BTU LO-NOX
Controller: HAYWARD POOL BOSS
Hayward Navigator: DEDICATED LINE FOR FUTURE
Pool Light: ONE 400 -WATT
Spa Light: ONE 100 -WATT
Purification System: N/A
Water Feature: N/A
Landscape: N/A `
Patio Cover: N/A -
Fencing: N/A
MISC. SPECIFICATIONS: ALARMS & SPRINGS PER CITY CODE.
Buyer is aware that oral representation or expression by either party is not 'binding -
unless detailed and signed by buyer and seller. �1`•
1
RBB @+12" existing wall
P/1
P/1
5'0
SPA @ +18
H,
'
quartzite spillway
P
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5
20;0"
WAL
7,0
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o,�Hx12'1
-
WO 15'0
existing
wall
existing wall
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.
bench '
U BRL( A33'9
E
SLEEVE
s
TANNING SHELF'
4
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13'67 -6n WL
24-9
N
—31'6,
.
.BLOCK WALL -
�
- '
PATIO
.. ._
P/A'
`
•
.. 4'6"H X 8'L'.'
0
COVER
decking
PA
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SLEEVE ALL
i'
light switch R PLANTERS
MINI
bobcat access'
HARMON
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P/1
t
t
. RESIDENCE
GATE
CITY OF !LA QUINTABUILDING
&SAFETY DEPT.
APPROVED GARAGE
FOR CONSTRUCTION
DATE
CITY QUINTA SUB-CVONR RACTOR LIST OWN 1Z f�
JOB ADDRESS4j Q x.15' J (PERM T NUMBEROLA
Y1� BUILDER
This form shall be posted on the job with the Building InsRection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authoriztoe'rk
onthisjob. Any changes to this list must be approved by the Building Division priorto commencement of work. Failure to comply will result in a stoppage of work and/or the v ce
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On`Fil&1.is not an acceptable response. - Q,✓, r, r✓_:
Trade / Clas t .n
Contractor
::.:..:. State::Contracto .s License ... :..
r.
Workecs:.Com ensation;Irisurance: `;: >:`;; :>::.:.
City Business License >
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp.. Date
(xx/xx/xx)
Ar
EARTHWORK (C-12).:.:;
pfN &0l
CONCRETE (C-8►: .. `.
O W N 1�
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FRAMING (C-5) ;.:°
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STRUCT::S7EEL(C-51)
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MASONRY.-IC-29)
PLUMBING (C-36)
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DRYWALL (C-9),:[:.::.:
4ECTRICAL..lC1!"101' : •:
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F31�`�1
S�Z. 1✓un,-J
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ROOFING'10=39):'
'SHEET METAL (C=431: '.
1
FLOORING (C:=`.15).: ' ` ': '.
GLAZING (C-17)"
INSULATIONIC721:
SEWAGE DISP IC-0...'
PAINTING (C=33) ;
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-131
LANDSCAPING (C=27)
POOL IC-531 v^' �T
— C70 C-AA I TI
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T-51 -