9908-202 (RPL)LICENSED CONTRACTOR DECLARATION
A
; 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
636128
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.
( `f 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.'
11 t1 F.11 y+.61 C.' �dlV
(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 complyawith those provisions-�
vDate: 'mak.' f • `" 4 Applicant"` -^R' --, u`.ti, -4,
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 3106
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 applicator 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
corre��"t. I agree to comply with all City, and State laws relating to the building
co s�truction, and hereby authorize representatives of this City to enter upon
t above-mentioned:properry,for inspection purposes.
Signature (Owner/Agent] `� -_. �----� •`'� W-» Date `ITS _99
;v
BUILDING PERMIT PERMIT#
DATE VALUATION LOTn!1-x��.� TRACT
1
SES,�14't}.f%9
t � jt -1-1 '
ADDRESS 45-39:4A,i9'H.W'OOD C.09JEC APN -
OWNER
LE:',A. MrtNt,
45-395A Si'1WOOD C O lTf
I.A. QUI Y.
USE OF PERMIT
Fiat,).!. ANiiAOR SOJA.
CONTRACTOR / DESIGNER / ENGINEER
CALIF01111-111A POOLS Al.11IM1 S
74-725 JONI DRIVE, 011
CA k)2253 PALM DE'SERT CA 02760
11M.13110-ORY)
K,.1OL ori. PA e3`NLY - AL Lf;2MS6Re1.€tiF`t,W SHALL .ti`ll's 114 114CE X
FRE- 1LF,36R INSI'E 11Ot2
POOL AND/0RSPA 106,50.00 I's
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yy,,�E T, g, MMA
AV.`aagV'TlgTkAF.t�, aV. V% '� °. i��41s�,T,�.�s'i wri�a� ui��vu�.v + .
PLAN C"tllFACK.. a—' It3131170)
FF tC97-f!aitl-C2e ( $ W.), ft,
$v;}d":AAANIC:AI, Mir,., .--POOL ,101-000.1121 iiT3(} s�'2.sii?
CiT4,"1'dt1i��A%:I^� [s --.PCs �A. 1C►1..t�L?f}-�d1t�-tl l SS450)
1°I fJ :fli"fde&: �-1F��7CJl k(T3-'Jt)f}-�i1Sa-6►42(?` 32'7JV
'r
4"119 t°A1, w�t'�j!�:�"l'1 �JC,Y+ 3.1•I .AND N.AN CHECK 993 ,Qf)
1ALES98 PRE -PAW, RIES $0.00
'COTAJ, J, P '.RM IT 11° C E S OV 1+:; 'Ni"lW r.4�11
RECEIPT DATE BY , DATE 5INAINSPECTOR
�a .
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.
Griils
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
7
Final I
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
Z •`Z 8-i `� f
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)
COMMENTS:
OUTSIDE EDGE FINISH
TG
54'-6'r
SLIDER
P/A
LIGHT
SLIDER
RESIDENCE
25'-g"
GIE
R6'-6"
8'
I
1�3
8'-6 "
Ful
-6"
I CONTRACTOR cannot assume res onsibili y for GENERAL SPECIFICATIONS
damage to curbs, sidewalks, driveways. cement SIZE 14 X 27
slabs, sewers, lawns,trees, fences, retaining AREA 334 PERIMETER 77 l
walls, sprinklers. telephone lines or shrubs.
When access is made through a neighbor's DEPTH 3X5
property it is understood that you, the owner, TILE CHOICE F -BLUE SQ. 70
have that neighbor's permission and assume full RBB 1'@+6" 12'9+12" t
responsibility. COPING CANTILEVER
DATE _ signature POOL CAPACITY GALS
PI IMP C'APAC'ITY 103 (,PM
R6'-3"
NOTE REMOVE SOD THIS
AREA PRIOR TO DIG
RT
;�-- R3'-6`1 OF
C�
Ppb®\1
+12" / 15'-6"
L BENCH LEAVE DIRT
MOTOR HIS■wmmwmml"P
FILTER STA RITE 300 SQ FT
FILTER RATE 102 GPM
HEATER LAARS SIZE 250 BTU
TURNOVER 2 HRS
SUCTION LINES '2 "
RETURN LINES 2 "
SKIMMER MODEL AMERICAN
CHECK VALVE YES
GASLINE BY SDC FT. 25
POOL LIGHT 400 W CLOCK T104R
ELECTRICAL BY. BY. SDC��160
GoNc,�'�F�V
POASTER
BY COLOR WHISE
DCQ605
FO
DECK TYPE SLT FNSH SD BUFF
STEP FT.
OP�� Zco,4OG SPA SPECS.
\ DESIGNER SIZE 7 RAISED YES +12"
\. LITE 100 WATTS
\� CHARD/EV RI LEVEL SEATS 22" 24" 27"
DATE DAMWALL 6 X 7 FT.
DAMWALL TOP TILE "
7-22-99 SPILLWAY SIZE 3 " X 12" WIDE
I REVISED SPILLWAY XX OPEN CLOSED
i l '?E -INSPECTION FEE OF $30 7-28-99 # JETS 4 UPER LOWER
1 SE CHARGED IF THE APPROVED
F _>>�+S AND 106 CARD ARE NOT ON dame: LISA ADORNO
AIRPIPE
THE SITE FOR A SCHEDULED
' Address: 45-395 ASHWOOD COURT
INSPECTION.
.NO IXCEPTIONS! �1�. LA QUINTA
P/L, TRACTINCA HOMES LOT#
BOBCAT ACCESS
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R&R BLOCK WALL SOV
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5 0 PALM DESERT TEMECULA
(211 d� 5
v N 73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
- 1/8"=1' SCALE PALM DESERT CA. STE 206
E 90
X&rING�WALL NOTE: LANDSCAPE AND FURNITURE 92260 92590
25iA CA.
ARE SHOWN F 90 90
OR ILLUSTRATION (760) 346-4032
ONLY AND ARE NOT INCLUDED. (909)676 -SWIM
1