9601-095 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B nQss and Professionals Cade, ar�d my
License Is in full force and effect. ��Itr h °t'1i'7
License # Lic. Class Exp. Date
Date Signatureof Contractor f. / .rte✓ - 3
OWNER -BUILDER DECLARATION
I hereby affirm 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
performancp,r04h9lwgfk for which this permit is issued, 1ZI2G7.>94
r ( 4),1 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 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.
Date: 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 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 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 for -inspection purposes.
Signature (Owner/Agent) _ . 1-4141- �� Data -1 c / _11/ ,�
i
ALC0
BIUII DING PERMIT
PERMITir4tllr-„�:•
,,,ul" OIL
DATE VALUATION LOT TRACT
JOB SITE ADDRESS RUHIU
APN
OWNER
CONTgAcLo�r DODSON CONS1'ItUC'i7ON
C11AFE1N .
6880.5A PEREZ RD #L'9
SAME
CATHEDRAL CITY CSL 922-14
LA QUANTA CA 92253
(OM324-1232 CBL# 104-1
DESIGNER/ENGINEER
USE OF PERMIT
_h .,FEE,., -SQRIPT10N. , . ,
FEES
E.�7'tMATEll <;CiBT C3C COr0i'1 H1X_7'1[ON
li't�.1tfl�t't' C+'t!,1;:C1JM11gAlt�'
PIAN �E11~ X, FM 101-000-439-318 $11115
CONS fJC*1'1GNFIM 101-000419-000 $171.00
IYtFst-'EIAN1Ci�S.'t F3s -- P.idI. 101-000-421-000 S21,00
PI.UMBIN(1 F01-- Ik”, 101-000-419-000 527,00
O.EC'MICAL FF.F -- POOL 101-000420.000 S45.00
r
r
r
SUB -TOTAL CONSTRUCTION AND PLAN Cif ECK
$378.15
LESS PRE -PAID FEES
$0.00
TOTAL PERINI T i±FUS DUE NOW
$378.15
l FEe 2 2 1996
ey
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 4Underground
Ducts
Forms & Footings Ir
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test g
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 6
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:
ALL � Lm D- X00
0
CITY OF LA VITA
BUILDING & SAFETY DEPARTMENT
d10NALL.
USUE-
,,.T TO jilq
�r 0.4 V• • • V. =�i �r e i <3 }J
AND ALL AFI�LIC ELA E
DATE BY
BACKHOE
EXCAVATION
OVER WALL
FROM DRIVES
pool & spa
light switches
a�D�KCGTj7N
CURE, PROPANE
SEWAR REROUTING,
BBQ, STUCCO, AND
WORK ARE NOT BY
5 -NT POOLS.
� t l
GFI ,RECEPTICLE
ELEC's :?JC STUB
FOR LIGHTING
t
6
.EXISTING PALMS
SPA SPECS.
GENERAL SPECIFICATIONS
SIZE 7'D 23'P is 39SQFT
RAISED +18" "
LITE 100 WATTS
TRI LEVEL SEATS YES
22" 24" 27"
DAMWALL WIDTH 6" X 6'
SPILLWAY SIZE 12" X
OPEN 3M CLOSED
JETS.# 6
SIZE 12' X 22' AREA 218
DEPTH =3'6" TO -5'
SHAPE CUSTPERIMETER 58
TILE SIZE GROUP 3
TILE COLOR CHOICE
RAISE BEAM 28'of+6" 8'of+18"
COPING CANTILE«R
POOL CAPACITY 8287 GALS
PUMP CAPACITY 90 GPM -
MOTOR .HP STA MAX 2 HP 1.5
FILTER SYSTEM 3 300 SQ FT
KREEPY KRAULI'
RAINBOW INLINE
TABLET FEEDER
AT EQUIPMENT
REPAIR DAMAGED
SPRINKLERS
FILTER RATE 100GPM
TURNOVER 2HRS
RETURN LINES. YES "
3 SPILLWAYS T1J..PfJ0L. "
MAIN DRAIN YES
SKIMMER MODEL DUAL PORT
CHECK VALVEFOR SPA
THREE FOUNTPA-N"::: - -
SPILLWAYS TO POOL
(UPSIDE DOWN ROOF.
TILES)
HEATER LAARS SIZE 250 000 BTU
GASLINE BYS.D.C. PROPANE 67
POOL LIGHT 40OW
SPA LIGHT 100W
CLOCK 24HR 220V
ELECTRIC BY S.D.C. 221'
ELECTRICAL BONDING BY: S.D.C.
TILE AND COPING S.D.C.
DECKING ES.D.C..416SOFT KC71
CONTRACTOR cannot assume
responsibility for damage to
curbs, sidewalks, driveways,
cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
or shrubs. When access is made
through a neighbor's property it is
understood that you, the owner,
have that neighbor'.s permission
and assume full responsibility.
SHOWROOM
73011 COUNTRY CLUB DR.#F-4,
PALM DESERT, CA. 92260
PHONE (619) 346-4032
LIC # A-57412.7 jef j' -lam b