0107-125 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury thet I am licensed under provisions of
Chapter 9 (commencing with Sbction 7000) of Division 3 of the.Business and
,-Professionals Code, and my License is in full force and effect.
License # Lic: Class ., Exp. Date
Date Si -A
gnature of Cort a�ZZ,• , 1j �'Pt
UILD R D
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 Policy No:
(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 C4Iif&rhia, and agree that jf I should become
subject to the workers' compensaitiop�/`provAon of Section 3700 of the Labor
Code, I shall forthwith complyfdwtifose� rov°�ns. .
Date31 V` t" Applicant ^�- .f _
—Warning:. -Failure to se—c'u', Workers' Compensation cover e nl''6 ul and
shall subject an employer to criminal penalties and civil fines Lp 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 authdrizolrepreserita NIBS of this City to enter upon
the above mentioned,pro erty foiinspecti"rr�p Fposes.
Signature (Owner/A,ge�n r ?� Dat T
i/ �J
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �r _41� F p%�25 TRACT
JOB SITE \
ADDRESS-
APN
:�
.,�'r.4.G:f� f1Y11.aA14�a.1[. A .W1�4.:.IC�
t7TJ"'i"� i�0.74d1i
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CA 92253
:k7.tALMDE .TM Q& 72 2.61
(619)568-4014 (11jVf 529
USE OF PERMIT
144 SXr" ULTTIC'E i91''sk`10 Ct:.iVEft C:!'XY STANDARVP5PA
OWLY-.A,LA..RMSMAR.RMS MUST SF:
rJb,VSPPtCXTIOMJIIO.OL aICLrO.'MRE I`TO ° T.tdC;LUDED rN THIS PERMIT
POOL, ADIORVA kjoo€totI,S
P0.RC .H/P'I T10 144.06 Si? '
wr#
p•��y�y� ,f �;. p��+y1�7 �p.�^p�^py+y y�
�`4d.i'CJ4 Vo Y' `..•W�:C.`t: c.R.1RT Gr AF .f9
q p� •�• S'.}�
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��vwh�••tt'F,[i�.7.5�.�.i}85. G81,dJ.R�.YII',�d.6R,ll�� _
, '
39-318
PLAN, 1034,C t*I'll. F"M 301-000-439-318
Co.i�Si':t'A' CITIC'K FEE 101-000,41113.3-000 $126.00
ST'FIZC's'NOM..0710k1 FRE- HYSID J91-000-241-000 $1.00
t�9 i:X°IA1rYbCs�tlr:?L ,.> POOL 101..000-421-000 $24.00
1y1:EMIUC11,P4L JFK -• POOL 101-000-420-000 $4,5100
;<yL';:MBYAM PF!Z >6 POOL , �' 101-.0004-19-000 $27.09
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JUL
L JUL1 3 2001
+ 1064,090
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+0.00
T OTAL PI&M. r"3.' F E`1 S DUE N!;3'W
r
RECEIPT
DATE••-" t_1 ) !
/BY
DAT qNALED
INSPECTOR
Z10 ./�9
ILq-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
)
Slab Grade
Return Air
1
Steel
Combustion Air
1
Roof Deck
Exhaust Fans
I
O.K. to Wrap
F.A.U.
I
Framing
Compressor
Insulation
Vents
I
Fireplace P.L.
Grills
f '
Fireplace T.O.
Fans & Controls
I
ikParty Wail Insulation
Condensate Lines
A
Party Wall Firewall
1.
Exterior Lath
i
Drywall - Int. Lath
I
Final /- 'Z-9 - v z
Final
{
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
t
i
Final
Underground Plbg. Test
Gas Piping
_ I
/Z?la(
6
PLUMBING APPROVALS
Waste Lines
Waste
Gas Test
Electric Final
Electric
Heater Final
Plumbing Final
O _a `
/jai—
J
Water Piping
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS '
hemp. Power Pole
Underground Conduit
Rough Wiring
tow Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
U.
'
ikv
- e-61�p'
7,t 17
CITY OF LA QUINTA
APPROVED PLOT PLAN
FOR CONSTRUCTION GENERAL SPECIFICATIONS
size x'Code;j "U
ATE BY Shape A'*6
V to
Depth 3 to
Tim cow 00 V
Coping 12* 4)" Cantilever tj 6
RE -INSPECTION FEEOF $30 Pw CWW4 yoo "S.
Pump Capacity G.P.M.
ILL BE CHARGED IF THE APPROVED
Filter
140,, CJO,-�fv, 2.. (10 Sq. Pt.
Pump tt�
SCHEDULED Fitw Pee j2-__
ANS AND JOB CARD ARE NOT ON . F - H. P.
T-IE SITE FOR A SC - S 90 G.P.M.
-OlTION. Turnover A Z Hrs.
NO D(CEPTIONS! Vacuum Line & Skimmer
Return Line
Main Drain
Skimmer AXAts,
Backwash to
Anti-Syplon Valle:
Size o B.T.U.
Heater
Clasline by 5UA144 P?- Ekmbk by
Ligte . / & 0
Time Clock
Decking
Board Color
Slide ' Color
o4-% U1,WUe_.
Nam 7 X Ad�l /V
Address' Zri—,' 3' 0 AsA /ie: 4
city b b4. qua w
Cross Sham
Phone 2-00 qOq-?
Doe
-&-oi Drawn by p4 -%d- L tr'.,4_
Of EP
ENO
SHALENDLOW
SCALE 1 /6" - IV*
SUNAIR
I POOLS
0
SINCE 1974
In BOX 835
P" DESEM. CA SM
PHONE (M 568JVM
39n UQ06E Cd33YPlS4
0
- e-61�p'
7,t 17
CITY OF LA QUINTA
APPROVED PLOT PLAN
FOR CONSTRUCTION GENERAL SPECIFICATIONS
size x'Code;j "U
ATE BY Shape A'*6
V to
Depth 3 to
Tim cow 00 V
Coping 12* 4)" Cantilever tj 6
RE -INSPECTION FEEOF $30 Pw CWW4 yoo "S.
Pump Capacity G.P.M.
ILL BE CHARGED IF THE APPROVED
Filter
140,, CJO,-�fv, 2.. (10 Sq. Pt.
Pump tt�
SCHEDULED Fitw Pee j2-__
ANS AND JOB CARD ARE NOT ON . F - H. P.
T-IE SITE FOR A SC - S 90 G.P.M.
-OlTION. Turnover A Z Hrs.
NO D(CEPTIONS! Vacuum Line & Skimmer
Return Line
Main Drain
Skimmer AXAts,
Backwash to
Anti-Syplon Valle:
Size o B.T.U.
Heater
Clasline by 5UA144 P?- Ekmbk by
Ligte . / & 0
Time Clock
Decking
Board Color
Slide ' Color
o4-% U1,WUe_.
Nam 7 X Ad�l /V
Address' Zri—,' 3' 0 AsA /ie: 4
city b b4. qua w
Cross Sham
Phone 2-00 qOq-?
Doe
-&-oi Drawn by p4 -%d- L tr'.,4_
Of EP
ENO
SHALENDLOW
SCALE 1 /6" - IV*
SUNAIR
I POOLS
0
SINCE 1974
In BOX 835
P" DESEM. CA SM
PHONE (M 568JVM
39n UQ06E Cd33YPlS4
r '
LAI 6
1411 +
" s14q4 It
1
t.%
APFROV
FOR CONSTRUCTION
E
I RE -INSPECTION FEE OF $30
LILI1 All BE CHARGED IF THE APPROVED
S AND JOB CARD ARE NOT ON
TIE SITE FOR A SCHEDULED
Olt3TION.
NO EXCEPTIONS!
f
t
///O�x 2 -
PLOT PLAN
GENERAL SPECIFICATIONS
.Size x /Z Code ,j eU
Shape !
Depth 3 >. to
-le color 6 o l
r A
Coping 12• �" Ciantll@Nef .7
Pool Capacity klO0 Gals.
Pump Capacity 0 G.P.M.
Finer Qlgy`, r. G.� z. y 0 Sq. Ft.
Pump L—At S e:�` 'W o H.P. {
Filter Rate y 0 G.P.M.
Tiirnovef
F_r
ENO
Vacuum Line b Skimmer
f-
Return Line
SHALLOW
!
SCALE IN" • 10"
u
///O�x 2 -
PLOT PLAN
GENERAL SPECIFICATIONS
.Size x /Z Code ,j eU
Shape !
Depth 3 >. to
-le color 6 o l
r A
Coping 12• �" Ciantll@Nef .7
Pool Capacity klO0 Gals.
Pump Capacity 0 G.P.M.
Finer Qlgy`, r. G.� z. y 0 Sq. Ft.
Pump L—At S e:�` 'W o H.P. {
Filter Rate y 0 G.P.M.
Tiirnovef
Hrs.
Vacuum Line b Skimmer
f •
Return Line
Main Drain
Skimmer cg /�v02✓�'-
u
Backwash to
Anti -Syphon Valle Fh. L
tib
Heater Size , . 0 C, .Q B.T.U.
Gasline by�5UAM-L 'L Electric
by $vim 4 c iQ
Light /&0
Time Clock 7-/ Q (/ ."..
Decking Co 400&. 4 -4 -
Board color
`v -
Sties �� - colo.
'�-��•.
�
Addrm 7e,-,,,3 o 74 S Ae_: L1
City L c4- P# 64g
Croee Streets
Phone 2-00 g O q 3
Dae %6 0 ! Drawn by: *•
. 0SUNAIR
POOLS
SINCE 1574
PQ am am
PALM DESERT. G 82281
PHONE " 506.,ww
SOUS UCENM C 53,MnM