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RPL (0305-263)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of l-- ,Ochapter 9 (commencing with Section 7000) of Division 3 of the Business and cit U "Professionals Code, and my License is in full force and effect. O n ch License # Lic. Class Exp. Date t- O LO r11601 Q13 1111 ..' " Z I-- Date—Signature of Contractors'- ,'._- �-CS� CD 0 t` I. -coo W OWNER -BUILDER DECLARATION aI hereby affirm under penalty of perjury that I am exempt from the Contractor's U) License Law for the following reason: Z_ ( ) 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). cr) () I am exempt under Section B&P.C. for this reason LO N Date Signature of Owner p N Q7 U Q 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 ?C AI i• 3' ? l*M Policy No. 22.0 Z)90(! (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 provision`s of,Section 3700"of the Labor Code; -I shall forthwith comply with those -provisions ---�- -... 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 atm• whose request and for whose benefit work is performed under or pursuanto any permit issued as a result of this applicaton agrees to, & shall, indemn`f<y ` & hold harmless the City of La Quinta, its officers, agents and employee I 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 suc 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 inspecti/on•purposes. }/ Signature (Owner/Agent) f� Date r/�/7� PERMIT # _ BUILDING PERMIT DATE � s-7,03 VALUATION $2tj, �t�.�:�i LOT TRACT JOB ADDRESS '70'-710 !"r1<b.1-Sl;Vl�.0A�, N AL,�'JA APN OWNERCONTRACTOR /DESIGNER /EN61NEER DOpp OGT�LUND CJAYVwWA ?-001Z, R4C . 78.7 3:� AV1..;;1 DA 3. AR .s FR?A 70. 80 't73UNIXT .ROAD 03 a:: A, QjJDNA, Glit 9225:3 R.*TC140 MTRA% i•F :;,k 92VU (`760)831.0960 CSIA 37',15 USE OF PERMIT P00,'L .&IMA) SP.tlk AI. R� wff3-%ARK5VRS SIihLI.R!E;1W P1,At;)•:.,A? PRZ-P1,AiVllr IP )NIS, %CIr0N• POOL ARWOR SPA 11.00 V 7-49M.09 LS t ,i rtT�'i. aC�' t • i.>�w.i �D ti:�9I`1� EST g �310N PLAN C`.I Frty" F+ t; W6.4F CONSTPIUt'.T101i ('�.; W"t-000-i 18-000 i"7'i.30 MECH.AHIM.V'.X-• 101-000-421-000 32+51"10 EVCTRIC'.t1L Y19; - POOL IU9 • Ufs:)�� L? -:;fes �'15.t3Q QUIt� A CITY . CF DEPT. RECEIPT I DATE Ji-wryt�f �'LAN'g CHT, 4 y{ 7 .LY74i J% rA14 Yl1ulffr V171w BITE, H0W BY 2a,mo.4 ? •'; t�,UCi Z115.1y4x 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 8 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 . Underground Electric Underground Pibg. Test Final Gas Piping .D f PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: U�'ls 7 2 �3 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) o. R r aha 4'tcc surt�arllnia ON I TI y j k. - '1 f , • , -,j.• i .j I -f: .r -f-- , ^� r ' r i _ . ,, ` _ .. D�Q Ffafl J�'�- ` `t"S ,.:r;;• wiIsReino�isd i r Aa � - t i _ ._'.�.._ .�--�. r- }}'.t ? J -..-r*__`.___. '.• -.L_ _r�,..r�,.�..--.- ._ - _.�-+•-• ":j_. _ _•.-_ _•-_-• - •--- _ -. _ _.. _ __. _ _..-_ ,-.i LY1� ING-�* -X �,V- �`= {'T• "'•1 t * �- - _._ , -" , :k �" { � M ��.i' -� I'r .r •�`~_• Iv_ t � i � c' I� _ � -- -, ..._ _. -_ _--� .. ._. .. � r- -"�--�. i`�_' -1' r C —___:—�J�LC�.._J T _ i Sidm Run 4 � Maul Drain�� �-IF f: 43 Un, pufft �i- Auto_ �_ _ _ - - _ _ __ _ _ -, -. - r�- ,- - - - - --- -.__ ._ ..... - ----- - • - -_ . SPAYOJ�b--_HDS—WATB� 'p >�X1 _ -Pkffnww-- O- - STEEL GUNRE Eno Sur ja!p ©- — _ .. _� ��-- _ . _ _ __ f _ a ._ ___..__ _ .. j`. , . f d �'-' �(�- - _ - - 6' RBB�.�_ 12' 18• 24'' f 14 CAL -NEVADA POOLS �^/ BrufCBes lave Seafs Spa Din YM10 t L NoErl1 ..r{ e. g _, , 9v&7 Mark V. Touw 70180 Thunder Rd. 7� Rancho Mirage. California 92270 Fax 760-770-7774 License 4 777601 Cell Phone: 760-831-0860 Te- -5 1 r. J-) r 3 1 � 20%0 W , ELECTRIC Total Run L/F 3*" FberppW Relrnate3� �•J ► =(3�,-�o.,r, 3 . �$,)T, TILE - stop A B.etri:iaer��► r S i�sc.-asters--®c. _ DECIODI6 ser R �-O Trve_3A_ o,!�. •-caor_n Ked Carvers Sq R- 0.0.0. UF 0.0.0.OF Step Risers Mist. SPA stm �% Arg a a Per 2 .z Pump S ,s ,•..c. Blower _ swmy-, c L asa ! `4 INTERIOR FINISH .3 Cow t c+ ouw G �Ss-rs is Fofs 1 1-.00 >, 2 M-ec) , Z 14154 1'h s u cz oaj OWNER to hm pool area and kaW self dosing and saaft gam Per Coot > NOTE: No dirt will be removed, returned or graded after day of mcvatlort" OWNER C r Lt V A)�D WITS: Relocation of equl vwd Pod wN ram in addMmW cost to owner. RITE: Ru pool i nmedbOeh dW PIOW (kftw btsinacbm). Do ad area rubber hose. ADDRESS ? i. a j eP* as i3 �T RIM Do not turn on pod Wit when pool is ein; y, p RITE' Wet dam cow" shell at Ictal twice dally for 38Mafar stW is lrtamM. CRY 3 SOLD f3Yjt�t OATS ,�- 21 -� 1- > IYe reviewed this plan and hersk S I a7. PHONE ZG (VV) s7 Z uY n DRAWN BY DATE 5-2-3 -- .