9601-057 (BLCK)P
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LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. ;33670 E tir""3i);96
dense # Lic. Class Exp. Date
Dated-/ Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
( ) 1, 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 a� c i~A Policy No. n r-rn•r:. 9C+
(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.
Dater Applicant _
Warning: Failure to secure W _ ers' 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 informatic
correct. I agree to comply with all City, and State laws relating to the buil(
construction, and hereby authorize representatives of this City to enter upon
above-mentioned property for inspection purposes.
""'I BUILDING PERMIT ' IPERMIT�6l1 -v�7 I
F---- .... _ .............. 514417,3 A` F— CAR:JRA' 7A I- I
OWNER
SUP: ROS1? CORPORA'1ION
72-8-% SONIERA RD.
PALM DESERT Gni 92260
(6.19)396-2144
USE OFPERMIT� NrE,R jt BUILDING
i�
65 .LY, OF 5' HIGH GARDEN WALL
FEE DESCRI
5 FT. WALL
SUNROSE COF(Po tA.110'N
172-550 SOME11A RD.
PA.LR'l DESE�W CA 92260
(619},346-2840 C:BL# 1.13'7
DESIGNER/ENGINEER
65.00 LF
PE RA111 FE'R, SUMMARY
( QNaS 1tUCTION is FY, 101-000-418-000 S35.Ot)
.rte..
SU13-*R3 'AL CONSTP,.1-)I""" 1.10N _>.ND PLAN C14ECK
% LESS PRE -PAID .FEES
✓4/V TOTAL VERXCY.VEP3 DUE NOW
0
61996
Signature (Owner/Agent). .. n+�.`'`! jA"'"�"-7 Data RECEIPT
BY
FINALED
INSPECTOR
8.,407.25
$35.00
$0.00
$35.1m
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 Main Drain
Bond Beam Approval to Cover
Equipment Location.
Underground Electric
Underground Pibg. 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 = OX for Finish Plaster
Sewer Lateral = Pool Cover
Sewer Connection Encapsulation
Gap Piping
Gas Test
"
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole r:
Underground Conduit c
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)
i
JCM Inspections
39725 Garand Lane Suite IF
Palm Desert, CA 92211
INSPECTIONS Phone: 760-275-5020 - Fax: 760-.327-8907
INSPECTIONS
EPDXY INSPECTION REPORT Date:
Project Name: Project No:
Project Address: C ity:
Client: Sub -Contractor:
General Contractor: Architect: Structural Engineer:
Anchor Bolts, �Rebar
IBC
Title 24
Epoxy Type: %
Other:
7�
Unresolved Items:
F-1 see Below
Description of Work Inspected:
LA 1-1
Work complies with written approval from Structural Engineer and ICC Evaluation Re iort #
I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best nUO' ability I have found this work to comply with the approved
plans, specifications -applicable building laws. Final report issued at project completion. 6;
Inspector: Jack C. Millin ICC Certificiti�o�n No: 0842216-49
Contractor's Representative:
Copy 1 JoM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of !j
O DIOCK Wall
6' Block Wall
P/1
Add New 7' square spa inside existing pool,
level with pool, 6 hydrotherapy jets,
staggered bench @ 24" and 26" at the highest jet,
100 watt light, 2 - 1' spillways
IJ21JL�jA�
31'-0"
6' Block Wall
Remove and replace
concrete, colored salt finish
Umbrella
Existing House
poor:
Equip O Alire�a
Replace Pool Light
6' Block Wall
p/1
CITY OF LA Q
BUILDING & Ej SAF
APPROV
FOR CONSTRUC
DATE.3 Z 2oI2gY___�
P/L/ at Street
P/L
6' Block Wall
P/t
Replace Pool Light
6' Block Wall
P/t
CITY OF LA QUINTA
BUILDING & SAFETY DE .
APTROVED
FOR CONSTRUCTION
DATE / 2 zol%y _
Size 21' x 14' 6" Volume 9500 Gallons
Surface 330 Square Feet, Perimeter 72 Feet
Depths: Minimum 3'6" Feet, Maximum 5' Feet
Excavation -- Elevation at -0-
Grading
Grass removal
Trees Deep end Ramp
Access Other
Steel -- Special R B Beam
Plumbing -- Pipe size : Suction 2" Returns 2"
Filter 240 sq ft
Pump - Existing Variable speed pump and motor
Heater 250000 BTU
Fill line 20 ft Skimmer
Gas line by Use existing
Back wash to N/A
Spa New 7' x 7'6 spa inside existing pool, 6 jets
staggered bench
Special
Gunite -- special
Rope rings Grab rails Seats
Coping -- Colored cantilever
Special
Tile -- Group 2 or 3 Special
Electrical -- Use existing
Lights - 1- 100 watt Spa light
Time Clock - Basic
Decking -- By CL Pools up to 400 sq Ft
Color - Colored Texture - Salt
Special
Fence --
Plaster -- White Plaster
Special Notes
Pool Cleaner -- N/A Adjust. Ret
Chlorinator -- Rails
Notes:
Hrs
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