0101-268 (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
Profe%ionals Code, and my License is in full force and effect.
License # ; - Lic. Class Exp. Date
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'
comperisation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Sectio 37,00 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.
ST,A E?tt3 ik 144-110•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 aggrreee, that if I should become
subject to the workers' compensation provisions, f SectioY00 of the Labor
Code, I shall forthwith comply with thopprovisiogs�
Date:g--.0 Applicant
Warning: Failure. to secure Workers' Com pensMion,cove rage is unlawful and
shall s6bject•an employer to criminal penalties and civil fines up to $100,000, 'n
addition to the. cost of compensation, damages as provided for in Section 370.
of the Labor Code, interest and attorney's fees.
IMPORTANT: -Application is hereby made to the Director of Building and Slafety
for a permit' subject to the conditions and restrictions set foo� his
application'. I
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 inspectiton purposes.
Signature (Owner/Agent),✓��' `Jr ! ' Date_
BUILDING PERMIT PERMIT#
//
DATE ; ) /� VALUATION LOT >��,� •• TRACT
JOB SITE r
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
114 Mrlff1
SVEIVE DOD::1M CONSTRt:Tii.'"1'1014 IUC.
78.61.3 r.7A1'U► I)i2I E
7.4011 C0112'URY CLUB iI3,,, 31731`1 E F14
LA.Q7aWA CA 92253
PALTA DNESEk21C41 X2260
C,760i)346-4032 C M4 1044
USE OF PERMIT
1"'001.AN1:'IOR SPA
P 00 L ai:, a..':i L3?43".X=,+`iLit ki68'3 9,R,PJEA.S 3HA118& W Pt.,AV, 9 AT PR ?I
1'1ac "✓ 'i l2 't S1°Pk�i l.t tl�•3st l;� '1? l)1fly'uYt:Pdi` f,04CWSURE 19 NOT 1xiyl.fill)1<T�
i..4. T)11.0t PERMIT
P010L ANDIOTt SPA 24,460A 1..S
ESMILA�'a� COW OF M."T"frRUCTUNNII,
2,4,460. 00
PXMI XT FEE' M. :fid! ARY
PLAN CSI ICK Me, 10')-000-439-318 S.1 °J: 00
Ru'1 14SMiPCT103E MX 14)1-000.418-000 $.252.00
MWBANIC'A 1 Ria -- POOL 101.Ot +30,421.000 $24.00
ELECTRICAL, PEP: " POOL, 101-000-A W -WO P5.00
T'T.T/mmNQ im .. t'i.?()1., 101-000-419-1,100 a-rt0n $.77.04
i S
5 2001 -
Ff£ B-Tt"Y AT, C0%MT['RUC"". t0.9,Mik•CPL�y[±3nrr��';+tTt1re;AC�� .
$5c1p1.80
3.2 FUS
0100
3
J
RECEIPT
DATE
BY ,
DATE FINALED
INSPECTOR
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
s
" 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
Vehts
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
Steel
POOLS - SPAS
ZI4
BLOCKWALL APPROVALS
Set Backs
Footings
Electric Bond
Main Drain
�) y
Z I Y
Bond Beam
Approval to Cover
Final
PLUMBING APPROVALS
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
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
&ZI—
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)
_s m _11. w k v _m3NT %—U-W,-
DOUBLECANTILEVERCAll
STRIP FORMS FOR FINISH 4
TILE OUTER FACE OF PBB
M 24 CUSTOM STOM CASCADES
OF SPA AS INDICATED
I 1 19- CLOSFD SPILLWAY
DOUBLE CANTILEVER CAP DOUBLE -CANT CON'CRETE CAP
PIA
PIA
A RE -INSPECTION FM Of $39
WILL BE CHARM IF THE APPRMW
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
DISPXTKK
NO Deal=
mliC1Y n.
S;ZF I. x .W
CITY OF LA
UIN-f
Y DE:)T-
BUILDING & $A
LAMILXIESIGUNA El EVATION APPROVFn RE
ED
.4ppR
FOR co t4sT,
' u c1lo 14
'?
OATSi,
BOB
A,
A RE -INSPECTION FM Of $39
WILL BE CHARM IF THE APPRMW
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
DISPXTKK
NO Deal=
mliC1Y n.
S;ZF I. x .W
- __
DESIG%ER
�R�A
LAMILXIESIGUNA El EVATION APPROVFn RE
RiTURWUNES
�Qy:ILECHOICE
GROR"PJ SQ, 54
SIIJMMEi MODEL A%4ERICILN
Rqp-.. 4W
�
C 46VANE Vii
COPMG CANTILEVER
2"BELOWMI'8911-1.
DATE
signamm
��CAPACITY
POMP C4
Gl�
POOL LIGHT 4W'lWCLOCK IRS•6
T PAL
'40-MIRlil' STA RITE
lip 1-1;
ADD VE.%4T—_CASCADE
MOTOR HP STA RITE
HP 37q
I&4V
FILTCR.. STA RITE JW_5qj�T
LAQt3ffAR0%4FS
MVDSFLL CROSSECTION
FILTER RATE 102
cmJ
P/A 7-il - - I :-I,-A - - - . A, PIA"'TR S�2�_!ILU_
.1w 0 * It TLFMIOVER 15
P/A
, ml
NOTE
I �t STEP 2A,
4.&.R E.Xrllll. ECA -IA'.
RESIDENCE
DETAIL FOR DOUBLE CANTILEVER
CAPON RAISED BOND BEAM
SPAOR 40"
POOL
WATER
"I, AIR INDUCTION PIPE
Has
DESIG%ER
7=7 RAISED .18.
RiTURWUNES
0
PIADECK
SIIJMMEi MODEL A%4ERICILN
T -Ir
�
C 46VANE Vii
DATE
2"BELOWMI'8911-1.
GASUNE BY SDC FT.
POOL LIGHT 4W'lWCLOCK IRS•6
T PAL
REMOVE EXssn.-;G soD
ELECTRICAL BY.SDC FT. iM
_.
_REiiviii�Tli -
ADD VE.%4T—_CASCADE
VV!6
R1d
I&4V
12-X 19' WIDE
_Vi
STACX
If A
-REVISED
By sm SQ 920
EEC.
)ANDY RS -6
TO HEATER
!Z-ir-co ORTHS
NkTTH SPA -SIDE SWITCH
DESIG%ER
7=7 RAISED .18.
G/E 60'
RICHARD SM
UTE-
LiTf, im WATTS
Tii _LEVEL _ SEATS2 j- T4;"_2T-._
DATE
OAMWALL t2' X 12 FT.
DAMWALL TOP C_ &p..
ADD VE.%4T—_CASCADE
R1d
_!;i:LWAYSIZE
12-X 19' WIDE
_Vi
STACX
-REVISED
0ILLWAT_OPEN CL
TO HEATER
ROBERT & REBECCA BIRD
78615 NAPLES'
_j
AIC,A
IXQUINTA,
Ly
MAST ER COPF, No
TRACT- BF9 I VISTA
(A
OD
ID
Ln
OPALM
DESERT TEMECULA
N
73-011 COL INTRY 28910 RANCHO
CLUB DR. CALIFORMA RD.
1/8,=rSCA
LLr SCALE
SLM F-4 SUITE 206
LANDSCAPEL_L_�
AND F'URNITLME
PALM DESERT, CA. TEMECL&A, CA.
92260 92590
ARE SHOWN FOR ILLUSTRATION
(619) 346.4032 (909)676swim
ONLY AND ARE NOT INCLUDED.
ILIC 9 A -CS 3-HIC-5 74127
p
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