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9605-013 (BLCK). _. . LICENSED CONTRACTOR DECLARATION in. I Hereby affirm under penalty of perjury that I am licensed under provisions of F_ Chalf er 9 (capmencing with Section 7000) of Division 3 of the Business and CV LLI Professionals Code, and my License is in full force and effect. p =) C,) License # Lic. Class Exp. Date O r "481851 C-29 950t.47 cc r` Z r-- DateS/2 ,,"t; Signature of Contractor, - O n C U M OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ D- 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). ( ) I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner ON CL Q WORKER'S COMPENSATION DECLARATION p Cc I hereby affirm under penalty of perjury one of the following declarations: U) � O () 1 have and will maintain a certificate of consent to self -insure for workers' X W I: compensation, as provided for by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit is issued. Q f) ( ) I have and will maintain workers' compensation insurance, as required by OU Q Section 3700 of the Labor Code, for the performance of the work for which this CC rn H permit is issued. My workers' compensation insurance carrier & policy no. are: It Z Carrier Policy No. 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, a d agree that if I should become subject to the workers' compensation pPovis ons of Section 3700 of the Labor Code, I shall.forthhwith comply withth'ese%provisions. Date: ,s� Applicant �� Warning: Failure to secure Workers' Comte nsation covVage 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 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, aqd State laws relating to the building construction, and hereby author representatives of this City to enter upon the above-mentioned property°f/orin pecti/io.,n purposes. Signature (Owner/Agent)` -r� `'/ Dat BUILDING PERMIT PERMITW1�1113 CONTROL# 3274 DATE 517/96 VALUATION LOT TRACT JOB SITE ADDRESS fi426li A�'>uNi��1 kII11i() AP" 774-23S-001 OWNER CONTRACTOR/ DESIGNER/ ENGINEER 1FRRY & GAY Cf [A1 I4N HEf If2Y YANFZ INTASON EY 54 260 AVFNIDA kUB10 71372 VIA i AIL 1.A Q1:1IVrA CA 92253 RANCHO WRACYF. CA 92270 r (610';328-2.272 CBII# 38 USE OF PERMIT +:ilsl�fliFttli. t31Ji1.1)INt.+ 5' #tiWt block wall 12Wng rw so exirti1% W-0 - Iwo comm. 4tY 1tU£C BXtf�litb tV#1fi - �.tti l'��ittE?: «)' 513"t'. WALL 12.Nf) L N;,ti'#'.1i�1t�l.'1K:f,�lYj�'d'1)i� t:t)N4"1'ul3(:"1'.ff�N 2�9.tili PERMIT VER NilMMARY r.: ON:1'MIC71CW1:i:L? 101-000418-000 30,00 SUS- 11FA.1. COIN 9rRUCT(ON AN PI.t1 N C14ECK $15.00 I,ESS 13RE.4'AID VJHKS '000 TWA][, PERMIT F..ES DUE NOW $15.00 RECEIPT / /, OAT �^7 �j By / By DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Furms & 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. 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 D 4f 4W 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 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring FbQures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: BACKHOE EXCAVATION OVER WALL FROM DRIVEWAY 28'+6" RAISED BOND BEAM W/ STEPUPS\ 12' ,6- l { GFI RECEPTICLE ELECTRIC STUB FOR LIGHTING t THREE bb w w patio & replace add decklid w/ kool deck forsewar . cleanout pool & spa light switches J . NOTE: LANDSCAPING, FURNITURE, PROPANE TANK, SEWAR RE- ROUTING, GATES, BBQ, AND STUCCO WALL WORK ARE NOT BY DODSON POOLS. �.f I SPA SPECS. GENERAL, SPECIFICATIONS SIZE SIZE X AREA RAISED DEPTH LITE WATTS SHAPE PERIMETER TRI LEVEL SEATS TILE SIZE 22" 24" .27" TILE COLOR DAMWALL WIDTH RAISE BEAM SPILLWAY SIZE X COPING r PALMS .OPEN CLOSED POOL CAPACITY GALS PUMP CAPACITY GPM JETS.# MOTOR HP HP FILTER SQ FT FILTER RATE GPM TURNOVER HRS RETURN LINES. " THREE FOUNTAIN MAIN DRAIN SPILLWAY TO POOL SKIMMER MODEL CHECK VALVE HEATER LAARS .SIZE BTU GASLINE BY POOL LIGHT SPA LIGHT CURB CLOCK ELECTRIC BY ELECTRICAL BONDING BY: TILE AND COPING +1811 22'X 12' POOL W/7' SPA 71P 260 SQFT .28' OF +6" RBB 8' OF +18" RBB 3 SPILLWAYS 5' DAM WALL 16' SAWCUT REMOVE 186SQFT DECKING 416 SQFT KOOL DECK 88 SQFT BROOM CRETE 24' STEPUP 18' DECODRAIN 67' PROPANE GAS LINE '221' ELECTRIC .36' PLUMBING ' AUTO POOL CLEANER RAINBOW INLINE CHLORINATOR REPAIR DAMAGED SPRINKLERS 233958218 CONTRACTOR cannot assume responsibility for damage to curbs, sidewalks, driveways, cement slabs, sewers, lawns,trees, fences, retaining walls, sprinklers, telephone lines orshrubs. 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. fltame:17 �.�LIP LV TH •Address• .54260 .RUBIO Qw LA QUINTA, CA Dog f -foo W Poo/w SHOW ROOM 73011 COUNTRY CLUB.DR.#F-4, PALM DESERT, CA. 92260 PHONE (619) 346-4032 LIC # A-574127 jefh d� d� o DRIVEWAY L W ti. .16' sawc3A new gate exist remove & replace gate in. 88sgft driveway 70' remove 98sgft 12' ,6- l { GFI RECEPTICLE ELECTRIC STUB FOR LIGHTING t THREE bb w w patio & replace add decklid w/ kool deck forsewar . cleanout pool & spa light switches J . NOTE: LANDSCAPING, FURNITURE, PROPANE TANK, SEWAR RE- ROUTING, GATES, BBQ, AND STUCCO WALL WORK ARE NOT BY DODSON POOLS. �.f I SPA SPECS. GENERAL, SPECIFICATIONS SIZE SIZE X AREA RAISED DEPTH LITE WATTS SHAPE PERIMETER TRI LEVEL SEATS TILE SIZE 22" 24" .27" TILE COLOR DAMWALL WIDTH RAISE BEAM SPILLWAY SIZE X COPING r PALMS .OPEN CLOSED POOL CAPACITY GALS PUMP CAPACITY GPM JETS.# MOTOR HP HP FILTER SQ FT FILTER RATE GPM TURNOVER HRS RETURN LINES. " THREE FOUNTAIN MAIN DRAIN SPILLWAY TO POOL SKIMMER MODEL CHECK VALVE HEATER LAARS .SIZE BTU GASLINE BY POOL LIGHT SPA LIGHT CURB CLOCK ELECTRIC BY ELECTRICAL BONDING BY: TILE AND COPING +1811 22'X 12' POOL W/7' SPA 71P 260 SQFT .28' OF +6" RBB 8' OF +18" RBB 3 SPILLWAYS 5' DAM WALL 16' SAWCUT REMOVE 186SQFT DECKING 416 SQFT KOOL DECK 88 SQFT BROOM CRETE 24' STEPUP 18' DECODRAIN 67' PROPANE GAS LINE '221' ELECTRIC .36' PLUMBING ' AUTO POOL CLEANER RAINBOW INLINE CHLORINATOR REPAIR DAMAGED SPRINKLERS 233958218 CONTRACTOR cannot assume responsibility for damage to curbs, sidewalks, driveways, cement slabs, sewers, lawns,trees, fences, retaining walls, sprinklers, telephone lines orshrubs. 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. fltame:17 �.�LIP LV TH •Address• .54260 .RUBIO Qw LA QUINTA, CA Dog f -foo W Poo/w SHOW ROOM 73011 COUNTRY CLUB.DR.#F-4, PALM DESERT, CA. 92260 PHONE (619) 346-4032 LIC # A-574127 jefh V