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0307-361 (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. License # Lic. Class Exp. Date 7`�5►L S ��ti23 e3i�' 5,Yll iJ'11 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 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 Sz �..fZ F`U31"(f Policy No. }'Gti�^ 6 -2©G'3 (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.< .Date: ? � .� r .. ,Applicant .-'r'�`''a' % ry .�;., r r � 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) �? / DateI' - s ".BUILDING PERMIT PERM'T���- DATE VALUATION r3y� �} LOT TRACT -r A JOB SITE ADDRESS 78-7425 MXLKS TAUVE APN OWNER CONTRACTOR / DESIGNER / EN (NEER " L'�.{., ��yy a����,A�l' t.'". 14 .1111 INS� ) gqA1141����Cuul�y'�t.����� (�aa� ! 8,,7 5 �R'rCLA , ',;'5F_ VE ���''ly}iEV14�� ��:£�YC�+3�:J111�' 4295 fes: � 11SJ.i�.`.�J•a'.'��K 1'I LA QU qTA ("A .92253 Pt,,T;.m IS 3 CA 9►2 2'62 2951 USE OF PERMIT ti r.":{s1 /JS fl, fWicat. :Jie•ht6YCJ ,R�i�J.'1 .6. StP:iA°[4'L[4,.. :. a'? rs; :�1�rs;sa l:. ct. iNs.'WTJO)T, DQ1VIPMEN 1MCL-JARED POOL - I I NOR 5PA X91 MddATO) colt"M `.J.[ CWfN7:TRUC(LUtl1V .tlao�'fCI4"1 ov, W;ldg€f rXV StaMi:RY PLAN V1HB43'_* PRl? a � ? MCsCip• � ��r i 1 � � y a'�, f� 102-0,00AW-00 a39y Og M7- CFi.4NyICpp.tpp�y�.}��FppEF, --`POOL. •:6//���J(?(?_a•/� <((. �(Z/Gyi/�1 Q1 /(�yT SIAZe71RICA L. Cl:+✓��II00�. ,101-I.!'VD-4110-©100 PrArrAW140 WEE-114:OL 14011.00(( 4191.0130 MIN a16.'fi.f"C.•�.,f �.C13.. ��}V, . i*�L/CM0,,Ci A'TSlD �VL.R'.iPE ViRi`..CK J���••• �� 1wF.,i 0 FSE+ PATID XM iL.fi© M. JAXNOM. `2003 1422 .70 JUL 3 0 OF IAOUINTA CITY DEPT: FINANCE RECEIPT DATE „ BY 71 WA CTOR 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground P[bg. 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 Vottage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: N W 0 a G - N tD t.D ro I m CN I M (S3 LO IN tD v CP 0 m C9 C9 CV CTs CV f� CD TOLM; WSIDENCI 78-745 N ES ST LA QUINTA A 92253 Rally -A SSOM POOL SPA L -99K 3010^ 610" R idt6: 14(r' Ver Surfs ftAw- 29G SF 29 SF Pcrkamer. 79 FT 19 FT Deptt,: 3'6"TO6'0- 4r MAX Damw cmwjole: 250 SF @. PATIO sodl13rave3: b}'desigfl. Ek E400n-L 50LF \ Raised Spa Bypm rskk Valae: YES Dedicated Vac Lbr. YES GarLine Ea'tta: 50' LF P/L Gas Line far BBQ -Tim It NIA \ Sae Ids: FM SPA JETS PSME Color w.�mh firdd, 578 SF DBCKNG, CAP @ RAISED SPA Cantilever Edge: 102 LP a Dc& Dmfw (per Lq: NIA SUV Riser (pe LFr NIA Dam WaIL +Ir@SP"WAY Raised Boni Beam: MIA Umbrella Slxve: NIA Basic Tile Grow: 302 IT GROUP l OR 2 TILE Qoarafte6owaterl : N_A Step Trim: NIA TAo Rued Areas 18 SF Ld AAM WALL spillwa} 5 FT WAR•FZITE walaw:. NIA BBQ: XIA Pinel t: NIA Booldrss: NIA Access Wall: DEMO 6t REBU11D Egaip� We3L NIA Paid,&uwa/F3asler. MUCOOCriRAISMSPAEXT Paul Fimis4: Wbke Pool Pl=c- YEs PebbiePoot: ?UA );golnmeeL• pump: HAYWARD NORTRSIAR 1-5 HP COLCWA NIA r. Fille. HAYWARD 00 SF CARTR DOF: TYPE Her. HAYWARD 2501: BTU LO•NOX Cacao! M: STA)MARD T&M CLOCK K Hayward Nasigala NIA Pool Llgu: ONE. 03 -WATT Spa Lust ONE IOU -WATT Ptaifi,-,a0on Sy3wm: AQUA•RYM SALT RSTEM water Fea6rz NIA Jaudscaae: REPAIRIRRIGATION Patlo Clover: NIA Feaeue: NIA &SPSCMCAnONS: ALARDISASPRIKG'SPERCITYOODE Bspnr 4 aware Chat wal repraeatWon or erpreWm by either pasta is not hladhq P/L P/A bobcat access PIA P"I IA 7'0 DHAO 8 REBIm-q TILS 400a& E AREA sleeve all planters PIA 6'9 ' �Spo set @ •18' ' �g 6 ute s-.11wa/ spa 1FVR BACKSEPS _ \1 6A5 - a P/A RUN �y-r--19'3 � ��..., /— P/L TOLMAN RESIDENCE %-745 N1011S SMET LA QLFrNTA CA 92253 amt VISTA P/A 760-778-2700 760-320-3667 FAk\ 2295 East Tamarisk Road • palm Springs, CA 92262 . License No. 779165