9808-136 (SFD)HM
N
.- W
O =) M
1--0LO
r
o Z ti
O O
� (O
C -)
Z
M
LO
N
ON
U °'
It CL Q
Lr) a 0
X W t l
O—'Q
mVU
O
a 0�
" Z_
C6 5
O
Q
J
.t
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.
;License # Lic Class Exp. Date
n2. 5x
, 7I31,i98
C� Signature of Contract`•D f i
OWNER -BUILDER DECLARAT ON
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.
( ) 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 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\n 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 pro.Cisi'ogs of Section 3700 of'the Labor
Code, I s'all forthwith comply with those provisions.
Dat .( 1�y Applicant
Warning: Failure to secure Workers' Com ensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any,permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws reldting to the building
construction, and herebq,authorize'representatives of this City to enterupon
the above-mentioned property for i'spection purposes.
Signature (Owner/Agent) 'DateCl ,'
PERMIT # CONTROL #
BUILDING PERMIT
98118-136
DATE t91 "$ VALUATION 5100,€ 09,40 LOT TRACT
8144
JOB SITE
,ADDRESS �: -. ' A.V?:a�i WA H1rria;VI RIDAS
APN -
773-145-06
\NER
CONTRACTOR/DESIGNER ENGINEER
_
DAVID R^,`,S �{tq1ER
PAlIFICRADSS CONSiIKUCrION
1719 S, T1UHM01,%Vf
1719 s `1:3tFh omr
OCEANSIDE CA. 92054
S 00'-ANSIDE.' CA, 920,54
(16U ;t 7-0064 C",BIX 195"
USE OF PERMIT
tiWEk h'.A.1 ILY L)WELI 1NCT
WO-PEi21v 1 "D0E3 N0 C INC'LULK BLOCK WALL OR POOL.
1RjkCT C'ONS'7`RU ION 4.64.6,60 '::MJF
ORCjU1?ATIO 46.00 8F
OAl2.te�3F;lCAt:f�.fi' 4F7 ;?U �+1�
6FT. WOOD FENCE 200.00 LV
%;,`�TU"1 X4Vf.,D COST OF C`i3i`.IST.R-U1 CTZ QtN1
100,30.40
CONSTR.IJG F10N FES 10? -000-418-000 9643.00
)'I..f1'.N CCFICCY tea i 101-0#S()•4�9-s $541 �1$
Yl1t/?1
i'OECHANICAL FU, 141^iitJV yi l -G00 $°s+ .51}
1115 U'.CAL FHE 101-ODG-420.000 $430-45
911UMBINO r. I 1,01-000-419-000 $130.00
tl',t RONQ NIOTTON F"FE - MSM, 10 1 -MO-24 I -ftoo. VA -04
zQUZALANG rte; 101-000-423-000 0110
04;RAS`t`RV:
INSPECTION RECORD
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.
FraminglIff
Compressor
Insulation
/6 d'
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
°—
POOLS - SPAS
BLOCKWALL
APPROVALS
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
COMMENTS:
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
�y
Final
Utility Notice (Perm) ���/%
Building
Addres 5 (-
Owner
�sa.J� f0
4 4 "
P.O. BOX 1504
/A�1178-495 CALLE TAMPICO
4, Zsf€LA QUINTA, CALIFORNIA 92253
Address !
0 C' s.. tr `rQ- f�
UK
p I Tel.
State LIC. ` L1Ity
8 Classif.i6(,'Z 1-W 1 Lic. #
Designer
Address Tel.
City (Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
n licensed under provisions -of Chapter 9 (commencing with Section
; �Cess and Professions =ode, and my license Is in full force and
OWNER -BUILDER DECLARATION
I hereby affII6 that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that -he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).
!: 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner oftproperfyfwho
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. Ir, however the -building
or improvement is sold within one year of completion, ,the owner -bunter. will have ,the burden
of proving that he did not build or improve for the purpose of sale:) �r\- i ,
I I I, as owner of the property, am exclusively contracting with licensed contractors to con--
strucl the project. (Sec. 7044, Business and Professions Code: The, Contractor's"License Law �1
does not apply to an owner of property who builds or improvesithereon, and who contracts, for -r
such projects with a contractor(s) licensed pursuant to the Contractor's License�Law.) '
0 1 am exempt under Sec. B. & P.C. forthis is reason `
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy NO. Company
f7 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thF 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.
Date Owner
NOTICE TO APPLICANT: If. atter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above•
mentioned property for inspection purposes.
Signature of adplicant Date
Mailing Address
City, State, Zip
%So8-136
APPLICATION ONLY
ILDING: TYPE'CONST. OCC. GRP.((
1. Number 'o 1
lal Description l Q y `I VCM K 110
A
Iject Description ,}
-14S-ot
Sq. Ft. ttq No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. _�F5O
Plan Chk. Bal. J—) J -
ylvlecli. - LJ'
- Electricals }
Plumbing
Driveway Enc.
Infrastructure
TOTAL
REMARKS
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION L
•
ZONE:
BY
Minimum Setback
Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback" from Property Line
FINAL DATE
Il`* ECTO ,
Issued by:
Date Permit
AUG 18 1998
Validated by:
Validation:
1 r rr. — .,°�/.,YY •- -,.
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION L
I
INSTAL'
Pool 'Md'S
Site Addivu,
TYON� C�E�TIFIGA`I'E'' '
a Heatiri S 'stems
Eal
Pool and Spa Heating'Systems requirements
§114(a): Systems and, Equipment.
I . Heater has a thermal efficiency that complies with the Appliance Efficiency Regulations.
2. Has a readily accessible on-off switch mounted outside of the heater.
Q' 3. Weatherproof plate or card containing operating instructions for the pool or spa heater.
4. No electric resistance heating except for listed.package units that has fully insulated enclosures and tightfitting
covers that are insulated to at least .R-6.Or if documentation is provided that at least 60 % of the annual heating
energy is.from site solar energy or recovered energy.
5. Heating system has no pilot light.
§1.14(b): Installation.
I . System is installed with at least 36" of pipe between the filter and heater, or dedicated suction and return lines,
or built-in or built-up connections for NtWre solar heating.
2; A cover for outdoor pools or spas that have a heat .pump or gas heater.
3. Pool system has directional inlets to adequately mix the pool water
4. Time switch which will allow the pump to be set or programmed -to run during off-peak petiods only
§150(p) Pump Sizing and flow.rate specification
-Cb 1. The pump specified is listed in the CEC database of certified pool pumps.
IE� 2. The pump flow rate shall be calculated based on pool sizing table below.
3. The pump is capable of operating at 2 or more speeds (not applicable if pump is less than 1 horsepower).
4. Each auxiliary pool load is served by either a separate pump, or the system is.served by amulti-speed. pump.
Pool sizin aloes are based on a maximum allowable turnover rate of & hours
Max Pool
Volume
(gallons)inches
Min Pipe D or Greater
Min Filter Area or moreWMI
(square feet
Return
Suction
Cartridge
Sand
DE
13,000
1.5
1.5
100
2.4
2017000
1.5
2
130
3.1
2521000
2
2
160
3.9
3028
000
2
2.5
210
5.2
4042
000
2.5
3
320
7.8
60
48,000
3
j 3
360
8.9 1
70
1 133
Note: For pumps greater than I hp. The maximum Pump Floww is the lowest speed dejasdt jlltrauon
5. Calculated volume of pool : �allons).
6. Return Pipe Diameter (inches).
7. Suction Pipe Diameter 2 , 12 (inches).
(� 8.. Filter Type 1/� f m t 6 1 V- C: jt dgl Sand, .DE).
(f], 9.. Filter Surface Area 0 (sf).
0. Max Pump Flow (gpm).
2008 Residential Compliance Forms August 200!
ATE
Einfirtement Agency: Permit
2of2
4' --k.
System Pipin
1. The suction side pipe is straight for at least 4 pipe diameters before entering the pump.(See table below for the
required straight run lengths for various pipe sizes).
The design uses low pressure drop fittings (sweep90's)
Pipe Diameter Required Pipe Length'
inch leading into um inch
1.5
6
2
8
2.5
10
3
12
Filtration Equipment
>
I . If a backwash valve is used: Tate .diameter of the backwash multi -port valve is 2 inches oras large as the
circulation pipe, whichever.is greater
JI
KA
KA
DECLARATION STATEMENT
1 certify under penalty of perjury, under the laws of the State of California, the information provided on this form is true and correct.
t am eligible under Division 3 of the Business and Professions Code to acoept responsibility for construction, or an authorized
representative of the person responsible for construction (responsible person).
t certify that the installed features; materials, components, or manufactured devices identified on this certificate ( installation)
conforms to all applicable codes and regulations, and the installation is consistent with the plans and. specifications approved by the
enforcement agency.
1 reviewed a copy of the Certificate of Compliance (CF -IR) form approved by the enforcement agency that identifies the specific
requirements for the installation. l certify that the requirements detailed on the CF -IR that apply to the.instatlation have been met.
I will ensure that a completed, signed copy of this Installation Certificate $hall be posted, or made available with the building
permit(:) issued for the building, and made available to the enforcement agency for'ti11 applicable inspections -
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to
the building owner at occupancy.
Company Name.4nstelling Subcontractor or General Cgntractor or Builder/Owner)
ReWnsible Person's 1�ame: Rcsponsitfle Pe n's Signature:
CSLB License: Date Signed: Position With Company it e)
o► ('1 1, l �? Z-1 Z
2008 Residential.Compliance Forms
August 2009