0010-100 (RPL)- LICENSED CONTRACTOR DECLARATION
I hereby affirm under penal%of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
lr� d L
�W`-
�'� 5,°3+'x1 1 A. �,� s O£stfalf2:f.
Z r atSignature of Contractor—e
O
(D O.r-
J
coo OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ W 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).
M() I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)d Q WORKER'S COMPENSATION DECLARATION
o 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo FZCr
p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
m_ Q performance of the work for which this permit is issued.
Q () "(� I have and will maintain workers' compensation insurance, as required by
O � Q Se'c^toon 3700 of the Labor Code, for the performance of the work for which this
4 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
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, and agree that if I should become
3 subj ct to the workers' compensation provisions of Section 3700 of the Labor
C�Od, I sh 'll fo hwith comply with•ttiose pt visions.
jDate: i!N � 6 i Applicant''
ri 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 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 9
construction, and hereby authorize representatives of this City to enter upon °r
the�above-mentioned property for inspection purposes. X, A t
Signature (Owner/Agent)+'".
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
7011.0f2cr2�s ? tiii
JOB SITE
ADDRESS
APN
/
OWNER
CONTRACTOR/DESIGNER/EN &NEER
KARL &.�.. 0STF21 IMER
SI`1`1±:'I E DODWC)N IC -O t�a`'`T 'CJ'C;CION ;WC.
r —S"':, rtt�rerrstaxn _55-2306 �g spe ��'
'7�40iI COWI1 ° CUT. 1.1;, SWIPE.1r4
LP. Q,.UlvrA Cil. 9 253
PALM, LSYMEW.0 CA 92260
C'f60)346.44032 C LA 1044
USE OF PERMIT
POOL &. SWA. ONLY. S"A, 8Z 114 PLACE AT
T,'k1t��•�€afl��'�':F'..Ik�,SYHr':ii�i�. �OC1I.,�•�b)7I?���'�€�` �;t�OT�i?5�3325� �� ad�;;+`1' .
114CLU11FA) IN THIS PER -MIT.
POOL, NDIORVP n'SOCL013 W,
RUMMIND d 09rOff' M1*09: UC,i)ON
.lP:if"RYtl IT.'BIT OU.f1riMtkRY
1°3.. N G ai��: � , :� l t1:t a(1�OQ•y.;� ►�;�1 ! 60
CONSTI,ZU11–"t'1s:tt FEF 101-•000-418-0013 �a4Atf.0
MI..CH.:'VICALPiaE- POOL 101000-42•1b000 M-00
EE.ICC U CAL. V •-POOL 10'A'..000-420-000 $45.09
PL I-114 I140 nrl, ..-pool, 101.000-419.000 sr/A
I'ma FIR" PAID J70:3
ZOO
� °'� ,°aEkt`7 ��U o NOW,
A'.:
M7.60!"' 7.60
--OCT 1 p =a
Ulf
RECEIPT
DATEE�� L R� _j#
BY
D INA NA
INSPECTOR
1. � • .0t1.' .. -/—/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace Y.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
steel
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
'Underground Electric
Underground Plbg. Test
Final
Gas Piping
�Q
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
3/$/
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
Final
Utility Notice (Perm)
N
0 STONE VENEER AT
a RBB& WATERLINE
ALL STONE TO BE
GOLD QUARTZITE AND
PALM SPRINGS GOLD
BOULDERS
STRIP FOR•HS FOR FINISH
SMCCO BACKSIDE OF RBS
ANDSPA
O
Q+
Ib
I AIRPIPE
M
0
ID
P_
l3'A•
P/L
4' HIGH
X 3' 1WDE
11INGWALL
3'-0-
3'-0•
THREEIB"CASCADES
WITH DEDICATED LINE
ANID SEPARATE PUMP
RB'9'
V '^VfILLa11lLlly..�41 ..... ............ ._. ...-... .._ ...
$12E -..- - 16 _X .A.. .
aFahc �"""� Janna -Imes,fe tainina ..r .... .._ .._ _
wadis Mdridem telephone Goes x shrubs ' K4_32 L"!!D EA 29
r(lrhen aooess is made tMouahane'phhor's DEPTH„3C-c
..__... __..
LA QIRPr1A HONES plppam, it A �.vM_.9�+d that vot•. tM owner_ E CtP CE OUAlt 8ilj ,$� 133
1TCTJ6ILL CR0.SSECTGDN i have that bor's UgMaigiM and .II .FM3 78'rd+IH^
fit- COPLK _ CkNTILEVER. _
—Ir
DATE -_ signature POOL CAPACLTY 9,90 --GALS
- MUD SQL R1MP.CAPAi7TY .10.. GPM
EXTRA 314 HP MOTOR HP -HPI e_
PUMP FOR CASCADES MOTOR HP STA RHE _ HP314
2' BELOW XLDSILL— FILTER STA RITE 300_5Q Ff ,
FILTER RATE_ _...__ q-2 . GPM
NEATER_SLAA E._.... Aoo BTU
P/L ._ER- -' . . "_t5__
SucnON uNEs 2_ —
RETURN L_WE5_--_2 -
�,� PALNI SPRINGS GOLD BOULDERS SKMMER MOOF.L. AMERICAN
CHECK YALYE— TES_ __-
GASUNE BY__ SDC _ FT. Is5
THREE 600W POOL LIGHTS CLOCKS i
ELECTRICAL BY. SDC -37a
-- - �_.�-- ---- ---- 11"3” --- BENCH -
DECO DRAIN I"
J - DANDY RS i G/E
WATERBRITE
RESIDENCE
A / LT trJI Y
BOBCAT ACCE
CITY OF Lcrl..�-
NO RSR
BUILDINGi & SAFE Y
APP R® i E gY1e�' t
DATE !�c .�coo BY
-
SHCETFLOWSPILL WAY AUTO LLEAI R ----
CHEM. EFOER WATER BRITE
TRAQ%fOTTECITO
EBBS E7\ISH SANDY BF_►CH
V-6'
CK EY-' SDC' SQ. am —
DECK TYP15LT FLASH PALO%IINO
--- --
S id
THE SITE FOR A SCHED D
SPA SPECS-
foods
DESIG\ER S _7 ....-RA-lSW +IB•-
PA'
JDHVlE LRE }00WATTS
ll LEVEL SEATS 22.24' 274
TEMECULA
BBQ BY OWNER DATE OAMW_14 6'X 6_ fT.
73-011 COUNTRY
DAMWALL UARTZ
t,'R"=I' SCALE
_ _
CdE STUBS BY SDC S-1SOD
SPILLWAY S17E 3 X 12' WME
STEI206NI4 RD
TEMEWLA CA_
REMISED YIAY_?.CPEd_ --
92260
# JETS -4. _OPER LOWER
�O�TEIV"EIER,.
A RE-INSPECTIP' -EE OF $30
TRAQ%fOTTECITO
> s
WILL BE CHARGFL f HE APPROVED
PLANS AND JOB ^IARD ARE NOT ON
THE SITE FOR A SCHED D
`°
foods
INSPECTION.
PALM DESERT
TEMECULA
NO EXCEPTIONS!
73-011 COUNTRY
289'0 RANCHO
t,'R"=I' SCALE
CLUB OR. SFE F 4
PALM DESERT CA.
STEI206NI4 RD
TEMEWLA CA_
NOTE: LAI;6SCAPE AND FURNITURE
92260
92550
ARE SHOWN VOR ILLUSTRATION
p_60)_i46 4032
6T.-SwlM