0202-124 (RPL)~ LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provlsions'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
736920 B
,Date �yf Signature of Contractor J j
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.
A( I have and will maintain workers' compensation insurance, as required by
S, C, ion. 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 STATS FUND Policy No. . 1".6409-2001
(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' compensationrovisions of Section 3700 of the Labor
Cod e,'I Shall forthwith comply witythgse provisions.
,Date° (;ZAln 1. Applicant's
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 Buildirfg 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
the above-mentioned property,fori s'pection purposes. ;
,Si'g'nature (Owner/Agent Date
• BUILDIf�G"P�ERMIT .'� • . PERMIT# �., • , „ ;i,� � � � t.
DATLP (S2Y %JIX VALUATION $1.2,CJd�ut'1{F LOT � 3 TRACT 164 -%JOB SITE
ADDRESS 52-540 AWNWA. REM1 E APN '7•J — ,`�b•L' '�'
OWNER CONTRACTOR /DESIGNER / EN (NEER
�3L31;1+13Cii:L.it1f CC'1�lR�POi�P 10E
Y.C.B01% 1141 51370 AWO ' A33M ii77I�b'
LA(9MTA CA, 92253 'LA QUNIT, QA, 9-0253
(760).64-1962 C_E�L.�f~' �Z�
a,•
USE OF PERMIT
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PC DUSP.A ONLY..A"RMSIBARRJERS ISHALL BE IN P,I.,A.CF,, RJQR To
PFill;PLAM.R INSPECTION, POOL CiQilITMEN1 ANCL.OS'trF; NOT YWC.`LC,11aRIP,
r,
.M PERMIT, i
POOL, fi DIfJI' SPA 1UN AA 1A
�:ru'" INA 0091 Or, f:°43RMUMOV
P1 .4N CHECK RE 101 -Vg) -439-318 s1!^1r' s
COAiSTRUCTIOW PILL? 101-000-418-000 $135.00 i
14ECkiM1CAL FEE -- POOLS 101 aS O -421-f. 00 $24.00
ELECTRICAL 1P9Z – POOL, 101-000-420-000 �t5.tiil
P11 M ING FEE Pool, 101-000-419-000
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ES 1)vc Now
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S:vfy®FL AQUIi"�t:'i .o
RECEIPT DATE / j. BYC DATE INALE INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings -
Ducts
i
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
[
O.K. to Wrap
F.A.U.
Framing
Compressor
j
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
[
i
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
[
Footings
Main Drain
j
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
s
Underground Plbg. Test
Final
PLUMBING APPROVALS
Gas Piping
Gas Test
Electric Final
_
.O
r
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
[
Shower Pans
O.K. for Finish Plaster
[
Sewer Lateral
Pool Cover
r
Sewer Connection
Encapsulation
91710
Gas Piping
Cc[
Gas Test
[
Appliances
I
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:
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P.O. BaxdSo
IA VUIM1TA. CA ." 922
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ARCHI'I-E117I'URE•8:e CONS'I7tUCTION
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POOL CONCRETE
DRIVEWAY
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P ER
PROPERTY LINE 60.0'
NEW SHIGHBROWN ��/ WATER SERVICE Z
BLOCK WALL J
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3) QUEEN PALM N i
5 GAL. OR EQUAL
AIN. 1 1/7' TRUNK
URB I AVENIDA RUBIO
3'. GATE
NEW 5' HIGH BROWN.
BLOCK WALL
POOL PLAN FOR
A.P.N : 773-2834M
ADDRESS: 52-540 AVENIDA RUBIO
LEGAL: Lorin [a.ouurca ,a.rrn
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EQUIPMENT
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PIANS PREPARED BY: .
LENI)f VENTURES, INC.
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LEN,I DESIGN GRO
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.ENCH II
PRF_SIDF
LENCH DESIGN GROUP'
P.O. RpX 450
IA QUINTA, G 927-13
Pnom:,("ICO)SN-lase YAM ()®)*,m2 )
ARCHITECTURE & CONSTRUCTION
LONGITUDINAL SECTION
.11 SCALE: NONE
32
BENCH
12" RAISED 12" 12"
BOUND--* .
BEAM