9709-140 (RPL)' LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O ch Lk.ense # Lic. Class // Exp. Date
LLJi
_.
oZ r— Date �' Signature of Contractor �' V
co
J U C) OWNER -BUILDER DECLARATION
W LU I hereby affirm under penalty of perjury that I am.exempt from the Contractor's
rA 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).
co () I am exempt under Section , B&P.C. for this reason
LO
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q U ) I have and will maintain workers' compensation insurance, as required by
O C) Q Section 3700 of the Labor Code, for the performance of the work for which this
li M permit is issued. My workers' compensation insurance carrier ,& policy no. are:
"t Z Carrier Policy No.
ob 5 1816141:'
0
J
(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 11 provisions of Section of the Labor
Code, I sfiallaforthwdth comply with those',provisions.
Date:°l `�s� Applicant'
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 fo 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
te above-mentioned property for inspection purposes.
Signature (Owner/Agent) ' Date--
PERM'i»��� Jed °°"TR°
BUILDING PERMIT 5989
DATE VALUATION LOT LOT TRACT
JOB SITE
SS R :; � .E � R 0
ADDRESS "�
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
USE OF PERMIT
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f`+['1t�; �f-tti iK'"f'1S iD� i�4ed`'a' f�j►f-flflf"Lai??-_fli�{t �'SRf,�� i$9�
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TMAL PERN11 _1411iN t * NOW
.4
OCT 0 2 1997
n
CITY OF LA QUID STA
:,
RECEIPT
DATE
c
DATE FINALED
INSPECTOR
Lt3Y
t�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Bac s
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing 1,
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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 AY
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping X.
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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
I
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Sent by:MASTER POOLS CORP Sea -26-97 16:40 from 7607765889->760 777 7011 Page 1
Received Sep -26-97 16:20 1 from 760 777 7011 -1 MASTER POOLS CORP page i
Sep -26-97 04:08P City of La QUinta ,760 777 7011 P.01 't
i�.
Bin K City of La Quints
Building tit Safety Division
P.O. Box 1504
,8-445 Calle Tampico
Perm -it �
La Quinta, CA 92253
Building Permit Application and Tracking Sheet
Ovmer's Name:
l>rojcC( Address: �-
Address: G
City's P, Zip: 4* e J
L,e�a{ Llesc�iption:
.,
M j' Telephone:
s:;t
C:olll/nCln(: 'll � � td
AQdless: ,y / / Project Description; "o jap C
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Ciry,ST.,7ip. Z X S
Telephone: +
State I.ie. 7 City Lie. t:: OJ �5
ArCh.. Cog- UnSigncr:
--
Addrrs,,
City, -ST. zip):
Construction type: ��UN, 76 C)^-Wancy: a
i'rlepht,ne,
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type (circle one) C6-i-)AdJ'n Alter Repair
Denlo
Stytr I,iC. +::
a:f; .:; .Project
Nvuc of Coutnct Person: $1 L C, N"A/461-4.2tO4
Sq. Fc.:
a Stories:
a units:
Telephone a of Contact Personz Estimated Value o ojet:t:
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NO AG49715
r ' G3X5&Sri
Designers & Builders Since 1958
73-555 Highway 111/Jensen's Shopping Center
Palm Desert, California 92260
619-346-6115
State License # C53-238947
4.
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CITY OUINTA
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SPECIFICATIONS
Size I�� ^'--� Volume I J Gallons
Template No.
Surface �. Perimete-1._ LIF
Depths
Depths M,nmyFn_--Maximum
Spa Size __ -b" PrJ Volume Gallons
,� ice'-_':. ._.��.__- �i.•�—.`v----- �
- i
EXCAVATION
mash Elenuon a Sr Method:
Access►`: Site Preparation
Grading
Dirt Removal!Loads to Du -
Dry Well Location t4 O" E- .
Fence Removed Br iN L- Replaced By p Material -�— .
Size of Opening----
NOTE No pa -ting or matching of texture will be donel
i
PLUMBING
Filter Type �' l�'CSize � -
Pump Type _ Size
Skimmer Type_ Size—No _L .
Heater Ty Sze
Heater VentBr
Jet Pump TVDe-"�-�1' Size
Blower Typ �— Size
Equipment Location 71 �'- ' L` P! lab Plt --
Plumbing Malaria __ tev ---
Suction Sze Length_-- Ft D,scnargr,S-z1_�_ Lgtn _.._. Feet li
Waste T.C-- ` __ S-ze _._--+_-._ Lengtr•
Returns,ir Poch Number _-.S,ze _.� Leg-- --... Fee,
Return In -et l vpe---
yy_ Fill Lme 1Wim No OMrrucvov s 1Size _-Lgr" Ft. A. S Va ve uocat,on
r Y% Gas Line By ---Lersgtti Feet.
Automatic Cleaning rd I<rw - !it�P`- -
SPA INFORMATION
Suction: Size .1-gth. — Ft Dischg.Size lgth. — Feet.
Jet Type Number
Jet Air Line Number Sze --Length . Feet j
Blower Return Size - __ Length Feer
Selector Valve Type —Number
Filter Type --- Size _—-- i
Pump Type —.—Size
Skimmer Type -----Size No —
Heater Type --S,ze _
Heater Vent By -- - —
Jet Pump Type Size —
Size
Eq�pernType
nt Location _— PIC SiablP,I
Plumbing Materia!
Suction: Size Length—Ft. Discharge Sae_.. Lgth.—Feet.
Waste To Size ---Length -length Feet.
Returns in Pool Number Gze Length- Feet.
Return inlet Type -. -
Fill Line (With No Otntruct,onslSize---Lgth.___— Ft. A;S Valve Location
Gas Line By Sze --Length—.-- Feet,
Automatic Leaning —
STEEL
Standard `Special
Raised Bond Beam: 6" 1T' 18' Other—
Spa Dam Watl: Feet
GUNITE )
Corner Rade �;.tom �1`�. r --C Inlets. _>!s. -__7r J�er�s.,--�.- j
Steps �' Fdl Line Location ._7-rlw- E---- 1
Grab Ra,' -09i Hand Pail _T Cup Anchors
Seat/Bench--
i
Spa inlormat,on _------ __- _-�� -- -- —_--
!— TILE AND COPING
Tile -_Color -�---_ CoP ng Other - —
Cantilever ..Vt-- F �
Trim:_-_�.� -Numbered Tile —.___
t
- Brick --_--N P "-
Special Detail: See "57EEL": "GUNITE"
ELECTRICAL
BUILDING 8. �7 TY DEPARTMENT By. --It4a--L—Light Cord Length Feet
"J" Box Location Switch Location -
�t rT�
Filter Run g. — Feet
t,. s`v�3I I Ri JS ti:` t Ft. Jet e! Ft. Light Run —
p (� (� _ � 1 (� y!(�p Switch Run Ft. Panel Change
-----
Spa
C;ET ( • � } f C t El rN SPa Switch ch LocLocvin ---
1 �.t-_• ��i" :,r t,. '� .. . ; 4�. Heater Switch Location -
SUBJECT TO INS4' LATION AS PER
DECKING
BY_-
- '!.... ✓Colo, - --- -- Cantilever ---Y ! -- -Rai Anchors-
Rise-%-
nchors -- - -
Risers-----------
Fi Expansion: r`
AND ALL APPLICABLE CODES Standards------
Decl, D,a,rL ----- - -- --- - --- -
BY_-' PLASTER
1) `: Lights --.—Name PlatesRecersed S.eps
Cup Anchors_ —RalA-hors 7t _Grills
DATE:
APPROVED:
A CUSTOM DESIGN FOFI:
i��
��ATE � SCALE
NAME
ADDRESS
CITY
PHONE
AREA
OF
CNK. BY `l, i `_ _� SHEET---