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9904-061 (RPL)D LICENSED CONTRACTOR DECLARATION I 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. LicenseClass Exp. Date f• / ©ateE ^l > Signature of Contractor OWNER -BUILDER DECL`A.F3ATION/ I hereby affirm under penalty of perjury that I am exerr pt from the Con Yactor'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. ( ) 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 C;,ARMDON IN,. Policy No. 011CRIM It (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 withiihose provisions. pate: Applicant Warning: Failure to secure Workers' Compensation coverage Is unlawful and shall subject an employer to criminnal.palties and civil fines up to $100,000, in addition to the cost of compensation, damages as prbvidedJcr 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, indemnity & 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 for inspection purposes. Signature (Owner/Agent) �' `• ` ,! Date BUILDING PERMIT PERMIT# 9904-4„6 1 DATE VALUATION SM01)0'” LOT TRACT k, ' JOB SITE 7 1 .'� I.SAIV b KKK T 1,,1VIII1 APN ADDRESS OWNtE,Rd CONTRACTOR / DESIGNER ENGINEER �qy ^�/'/y,.+� �/p 78-945 j3AYf3EtiKY LANE: 2318 S. V1 b! EYAWD AVENUE I'A' QLT N"r A CA 92253 ONTA.W CA 917151 (909)947<0474 +CBb# 5240 USE OFPERMIT POOLC'�,�C�L ANY)i0k SPA RB LJL..f.3k°ti, 1A� 7ltCi41c9ttSNliYC3NtG�'9 ;, #vALL W• ll i tA.1 k'.RC -t' RR 11 Jtl 11.1�l1'�C; l'iON. MKOL t`,�v'WORPA. 17/ . .000.00 L 3 14 d.'NSIVS.ill 1R.,fiaD 4#LYw, �.1A'R./rbR1AY�T1`.iJt,� all A'�fIYJ,AVtt KAN C,ttR°.�t..f,. YH 101. -qui) -439-318 $117.90 CC'iNS'Y'Riif;rYiNFFF. W11-M01-418-M)Sfftkno i�Ja5(�iTiMCo'��..�'1L�5^-i°fiE11. ,Pt11_000 42I-0001 3`4A) EL► C.'J,R7#CAL .Ffxir3 -t 001.. 101.000-420-000 $45.0 i✓.t.t1M11INi}VEX- M-b%OCI 1{31-420(1-�ii?f-tifltl $�7.(a!► $UB-D"MAL C ON iTRUGRON ANE) PLAN C ICK �393.0E� LESS PRE -Nm r-te's $0.00 .t'MAL PEf NUT.i+EEN Dt2.i,�NOW R CEI T `, �- DATE BY DATE FINALED INSPECTOR \t` A INSPECTION RECORD a ti 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. Grills Fireplace T.O. Fans 8 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 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: REAR P/ L 5' FEQC-E 1-D IN. S>'A w/L 1 VL4 PMD RAIL 1 j .:. E FY � ' CONDITIONALLY ACCEPTED FOR CONS F Wt Itt cE SUBJECT TO INSTALINATM A&2W L U MILL hirr-Lllr/1 E A-rIAC-I-kED 509971' J:af2 CL/=cTWvac u Pool Builders BWE(ZSince 1954 (909) 947-6474 • (800) 479-5560 Fax (909) 947-4393 HRER POW2318 S. Vineyard Ave., Ste. A Lic. No. 618892-C-53 Ontario, California 91761 'i4�pMAS GU I Cr MP 849 -Gil (-/5 LOLDZQL)OK L f.1, MILES I&A'g3r X L1, GENERAL POOL SPECIFICATIONS: (Temp - SUR SUR. MAXIMUM WIDTH: 110' PERIMETER:aZ ' AREA. 2A MAXIMUM LENGTH: 3t' POOL CAPACITY: 3 q00 GALS; Pr)r)i DEPTHS- 37%.'-M r TURNC)VFR RATE W- EXCAVAT� Access Fr Rear Bob Cat Shuttle Dig Remove Dirt Remove Stump(s) Risers Remove Fence Replace Fence Remove Concrete-S.F. Mastic 5 Sawcut Concrete Ft. STEEL Expansive Soil Steel Pattern BH PLUMBING Filter Run Ftg: Return Lines P -Trap B/Wash Line Gas Line Ftg 1I0, Drill Drive ELECTRICAL fib, Run By Ftg GUNITE Love Seat Swim Out Ext. 2nd Ste R.B.B. i Ft. R.B.B. in. X Ft. COPING Type TILE Type Spa Dam Accent Tile DECKING Type -_ C.D AJ �� Color Risers Footings Mastic 5 Drains EQUIPMENT Filter Tvpe64ZT- Size 4,5b> Pump HP 2SP 1 S B.H.C.C. Yes ON o P/P+/Or Ozone Yes SmartLi ht Yes afo 500 W Light es No SmartVac II es No Heater BT Nat Pro Div. Board Slide Water Feature: PLASTER _ color SPA Size In Out Plumbing Run Dam Wall Length Number of Jets Blower Hp Yes No Remote Model # Spa Side Switch Yes Qt c SmartLight Yes 100 Watt Light es 7> No BUYER Initials • Approve above specifications • Approve equipment location • Understand that decking shown is for illustration purposes only and understand that they are to receive 4M0 square feet of deck. Signature Date Prepared Especially For: ST&), LEY l •R2A),L.IKSE COX Street -76-84S 9i`iZa*�`( LA, City L -4b, y I K37 -A- Zip CT 2- Z -S3 Home Q0 32-4--51 ZQ_ Work Phone Designer ►J K3 1 Job No. Lot Block Tract Mapsco No.