RPL (0303-035)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
e#G Lic. Class Exp. Date
053 kY,�Ii� C -0)
t 0131W
Datet} Signature of Contractor I�1t^� �� _.
"lY- j,
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:
Carrier ST.�Tt+;€ omP�73�Mai Policy No. �r1G-6lti�-�4t73
(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
visions.
Date: t Applicant—
Warning:
pplicant 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
the above-mentioned propertyjf�oginspje�ction purposees.
Signature (Owner/Agent) fes" "h�4� t'r`r Date'
f.t
BUI.W NG PERMIT PERMIT#
s
VALUATION .. fi)�If "0X4
DATE , LOT TRACT
JOB SITE�
ADDRESS:.^3 _p11%1)VR.i�RAw�A:a
APN
_
OWNER
CONTRACTOR/DESIGNER/EN (NEER
MR. Ai /0R MRS. IMMMAW
W .t' ORMA P001.E VAS (TOP MAN C01
$1 05.5- NIC1MMIX,"MIACM.
86.100 A,,V i 'YF, a4
1A,QjYfrrr`A , C�� 92253
0 0 CrM:LLA CA 92226
(760)398.92,22 Mul 00355
USE OF PERMIT
POOLAND/OR MPA
POOL, SPA,, B BQ(A:NS1 XIV.A, 81,11. $' BLOCK
WAIL, CTT'' RTAa DA11 D, ALARMSMAlt➢ OW SHALL BE 1.1 PLACE AT
PR&PLASTERMKIACf1ON. ��
�.�. a �! On
3 yr. VA) T, U0 LF MAR
POOL A WA'7 OR SPA 27r LM'I
2 4 22,7J3
CITY
7EF LA QUINTA
FIRANCE
F-`EPT
4ti
1113ZAM IRE StFMWIA "I
PLAN CHWX = 101.9.0 -439-318 515;193
CONSTRUCTION PEE 101-000_418_000 $243.00
Mtf'.H!1NICA6FEE --POOL 101 -000 -421 -ON 1124,00
t*x..W:'i RICft,l,.ITUt - POOL 101-000-4.20.000 WX'S
PL1,Nrr11HI G ME •, Pool, 703-000-419-0W $2710
SUB -:1170` 1tC°ClM1'J ::DC17iO3 AIM PLAN +CH+':f K
$496,91
LESS T'.RWAN4:o:Fm
$0,00
TMAX, .x""E10MF VE YiIf#E NOW
$496.95
RECEIPT
DATE i
BY
DA E INA
INSP CT
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings _3I A91
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
!,Nater Piping
Plumbing Final
1 lumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
ewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Q �/ � 'S7L�G%
ie)
9e
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)
03/18/2003 17:12 9496314453 DAVE FREIMANN PAGE 01
03/:81 7UU3 13.4d tbb]b4«!LNJ rr-411G u:: oL
0.0
FAIRWAYS ASSOCIATION
March l8, 2003
Mr, & Mrs. David Fre7imarm
81-055 Muirf-ield Village
La Quints CA 92253
RE: Application for Pool, Spa, BBQ, and Boulders
Ae� Iyir. & Mrs. Freiana:
At the Marcia 17, 2003 Architectural/Landscape committee ameetizLg the plans your
subnii,tted were .re"Viewed and approved with the following suggestion — use low growing
shrubs instead of the hibiscus.
If you have any questions, please contact me at (760) 564-3858.
DM/ncp
CC: California Pools
Post QL-tic.c Box 1 C58 , La Quinta. California 92253 • Phor-e (760) 564-3859 Fax ('760) 561.2329
IJ oT e s
I.-ALL PAINT' FOP- PLA5TEP- P . RE E LAST° MELIc- _
-2, VEH FY LocP►T I ° N OF GA5 'KEY' w/ L. A•
3. FIIzEPLAGE + (:56 IP9T#-LLE0 w/ L-g65 ar�.raA5 FLAME EHITTE� -VERIFY
. w/ 0�•1 N E R .
q.-tmF.i(a&p,cY 6A5' WPP. SHUT--OFF- �/ALv& {� Mb L'C^TE;o UPOLF. 45AS ONLL
-It OuT�p- KITGNEHI.
6'-6• J
t
I -
V-3' V-6-0 V-3' V-0• L V-6'
OF
CLAY FLUE
! TEX.EXTPLAS ER.
8' CONC.BL TYP. _
N
i4: CONC. SLA B.
Tl
I ( +
FIREBRICK I
4 fzAo.
#4 BAR HORIZ. CONI.
VES. I
4" RAD VEX.
TEX.EX1. PLASTER.
WBARS HORIZ. @1 O.C. TYP.
' 2' CONC BLOCK. T P COURSE ONLY.
SAW IT AS RFot MY fi I 4'x4 STEEL
#4 BARS @ 18' O.G. TYP.
#4 BAR HORIZ.CO .TYP.
- I. i
i I BARS VERT.' @1 O.C. TYP.
#4 BARS HORIZ. TYP. ( STONE HEARTH
_#4 BARS HORIZ. T P.
Vic. )•..y, f " 1
.. , '. -•�J,-'i -�+,�f I #4 BARS @ 18' O.0 TYP.
.o TE .EXT. PLASTER.
PATIO SLAB.
NOTE: #4 BARS.@ 12' O.C. EA.WAY.
SOLID GROUT.ALL CELLS
WITH STL. REINFORCING.
FIREPLACE DETAIL.
SCALE 3/8"=V-0°