0007-106 (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
Professionals Code, and my License is in full force and effect.
,:%r_-ense # Lic. Class Exp. Date
ss��74g .•? A. O8f 1,��(
Date 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 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
perfo ance 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 STATE" FUND Policy No. 046-00-0007934
(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 oPthe Labor
Code, 1 all, rthwith comply wit those provisions.
Date:����
Applicant -91
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 property for inspection purposes.
Signature (Owner/Agent)Date
l
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OW7-1•()6 TRACT
321,108.
JOB SITE
APN
ADDRESS 78-596 -NAMIM DRIV1:'
- -
OWNER
CONTRACTOR / DESIGNER / EN (NEER
8TfiN Istat AY SASS
STEW DODSt1N' CONSIRL3'MONINC.
711.596 NAPY,MD1?.IVE
73011 COU2NMY CLUB DIL, M -1111°R F4
Lk Qtl".t1�T rA CA ' 92253
PALM MMt.'S C4 92260
(7601446.4032 CBLO 1044
USE OF PERMIT
POOL AM1OFt SPA
POOL,& SPA 0NLY.r.1l:.ARAt WBA.R.R1142 SHALL SE IN Plt CI: AT [SPP.
PLS.STP.R.INSPECTION. POOL EQUIPMENT KNIC )SURE IS NOT 1NCLUDED
114 THIS PERMIT. �
POOL ANDIOR SPA 23,100.00 I,S
XSMI 117D COST OF CCDMMUC1€70N
21,100.00
PEIR:MIT MME SIMMY
PLAN MEC KI FEE 101-000-43%318 $146.25
C O' NSTRUCTION FEE, 101-.000-418-000 $225.00
�
MECHANICAL FEE -• POOL 101_000421 -000 324.00
I?l:.IF,.,CTRIC.A1. ME _- POOL 101-000-420.000 $45.00
I'LITMEi O IEE -• POOL 1.01.000.419.000 127.00
t 4:a
rt
SIB-TOTAI. CON'11' i TJMO2N' AND PLANT C"FI}EC�`K
$467.25
ypr{}�y
g� r IMS PP-&PAII7 IMS
$0100
PAID T O'I',AL 1'E1Z ur 111n, S DUS NOW
X7:25
JUL 18 200yy��0
.oITY 0H.1 I1 ow,.
C
RECEIPT
DATE
EY/ ,+ !
DATE FINALED
INSPECTOR
+S% .
4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Becks
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
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Z5r
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
Sewer Connection
Pool Cover
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)
+12" RAISED BEAM
1 "WIDE
custo cascade
P/L
3'10
planter area 2' OFFSET
ri
.6" poured in place curb 12 -6
n' s
271-0" BENCH 3
30'-0"
r \ /
P/L 2' OFFSET �� — l7'-6" > _
— 6'-0"
18" OFFSET
LIGHT SWITCH 11'WI-0"
/ 1
ID
SLIDER SLIDER
G/E
KITCHEN LIVING
�® VENT STACK
6-6" — ON HEATER
RESIDENCE
BOBCAT ACCESS
R&R BLOCKWALL
NOTE : PAGE 2 FOR CONCRETE POUR WITH
CONNECTION TO DRIVEWAY THRU GATE
I
t
6"
7'
T OFFSET
9'-6" 17-3"
SLIDER
R
MASTER
slabs,- .ns.trees, fences, retai�.
walls- sprunklers. telephone fines or shrubs,
When access is made through a neighbor's
property it is understood that you. the owner,
responsibility
D•
SIT & SPIN SPA VERTICAL
FINISFbEcK
DECK
VENEER
GENERAL SPECIFICATIONS
SIZE 1216 X 30
AREA 310 PERIMETER 80
1FPTP 3X5
RBB. backside of pool +12" -
COPING cantilever
Pnnl CAPACITY 12.000 (;AI
MOTOR HP STA RITE Hp 1.5
MOTOR HP --------------------HP
FILTER STA RITE 300 SOFT
TURNOVER 2 HRS
SUCTION LINES 2 "
RETURN LINES 2 "
SKIMMER MODEL AMERICAN
CHECK VALVE YES
GASLINE BY SDC FT. ALL
POOL LIGHT 400 W CLOCKT 104R
ELECTRICAL BY. SDC FT, 250'
AUTO CLEANER -----------------
r'LIC\A ==D --------------------
DE K BY SDC SQ. 1156
DECK TYPESSSALT FNSH S.D.BUFF
LA QUINTA HOMES STEP CONC FT. VENEER
MUDSILL CROSSECTION SPA SPECS.
DESIGNER SIZE 7' RAISED +18"
HOUSE RANDY LITE 100 WATTS
MUD SILL RI LEVEL SEATS 22" 24" 27"
!� DATE DAMWALL 3 " X 9 FT.
DAMWALL TOP "
TA 5-2-00 II II
C� L SPILLWAY SIZE 3,,x 12 WIDE
nplREVISED SPILLWAY XXOPEN CLOSED
APPROVE® �it,�� QrtK LUV,
FOR CONSTRUCTION Name: STAN AND KAY SASS
; Y 78-596 NAPLES DR.
t��ATE2Ug4LAddre�LA QUINTA
TRACT BELLA VISTA LOT#-AINSPECTION FEE OF $�E CHARGED IF THE APPROVED ®® ���
,.
PLANS AND JOB CARD ARE N-01 05 =
THE SITE FOR A SCHEDO
MISPECTION. POO/S
.NO EXCEPTIONS! T
{.. PALM DESERT TEMECULA
N 73-011 COUNTRY 28910 RANCHO
1/8"=1' SCALE CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. ULA CA.
NOTE: LANDSCAPE AND FURNITURE 92260 TEMECEMEC
92590
ARE SHOWN FOR ILLUSTRATION (760) 346-4032 (909)676 -SWIM
ONLY AND ARE NOT INCLUDED. I ,. A r'�,1,
I
Name* STAN AND KAY SASS
Address* 78-596 NAPLES DR
QjW LA QUINTA
TRACT BELLA VISTA LQT# 9
..........Ger., .1. -* -
. . . . . . . . . . . .
AgOdS011
Poo s
PALM DESERT TEMECULA
73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. STE 206
92260 TEMECULA CA.
(760) 346-4032 90 .92590
( 9)676 -SWIM
LIC # A-574127
t