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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter a (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,,,
Date( Signature of Contracto
,.,,, ...............-..mac..
OWNER -BUILDER DE LARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(-')' 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' compensaeti6on proyisioAs of Section 3.70,, sof the Labor
Code, I shall forthwith comply yriffi thou provisions. ,, i ,J
Warning: Failure to secure W?fkers' 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. r
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
construction, and hereby authorize reejesentatives of this City to enter upon
the above-mentioned prop rt 11y for inspection purp ses -"j
Signature (Owner/Agen
A, 1 BUILDING PERMIT PERMITM
DATE rf VALUATION LOT TRACT
90 29147-2
JOB SITE APN
ADDRESS
57 761-140-01.1
OWNER CONTRACTOR / DESIGNER / EN INEER
,C"Ak.tMAD CA 92008 C-4AW.58AD CIA 92008
k)60)804-686 C13xA 33715
USE OF PERMIT
30"0.1.�Hi: WA' 9D y�y'�t+..�y�'g1�1 )Ay -a IY�(L+��ye�Uy#I6T�Tgb)O= Afiai T1�1?ral..lfElf: 835. C3CK aY �43,iu,
P001, OR DRIVEWAY f3.[9C.96'6.+3DLi",la
CUSTOM COi78°i`&UCTION 2120.011V
PORCH'4P,ATIO, 539.0 sp
GARAQUICARPORT 9103510
Y�'.�'3.�t XrF...L1 CE?�a"I' Ole C°ti.�,i�tv".'�1~ UCI`IE;ON
1.91:.,342-50
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JUN - 5 2001
CONSTRUCTION IEEE
103.01 0.4183000
W1301
FINANC OEPT l,,,.C;
k'i!.,r9N CHECK FEZ
101-00".39-318
STA -.99
MECHANICAJ, "M,
101 -(=I -421.000
moo
F'I_ltt:9 RJV1A1114PIA
101-000-420-000
$121.30
PIIUMBIN43":i,
101.■000-419.000
1)1ts 17.5
aTRONC1' MOTION 14rE • RPSID
101-000-241-000
$19.13
ORAD1NC11t.U,
101.000.423.000
W.00
:OW'.1r,4.,iJiyW;, IMP.AC T 'FZF
ifl;9.SYt.QO
Sil"J18-10TAf., ®9 '8 111I�`i�
M F1..T8MT MS D021,110 WSW'
BY
$I.„057,(n
$0100
MA457,67
W � ,.
JUN - 5 2001
RECEIPT
CITY OF L WNTAJj
FINANC OEPT l,,,.C;
M F1..T8MT MS D021,110 WSW'
BY
$I.„057,(n
$0100
MA457,67
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
_
/f6�Ducts
7 /�D� �`
Return Air
Steel
_ _
Combustion Air
Roof Deck
b/
Exhaust Fans
O.K. to Wrap
_ _
F.A.U.
Framing
�Q . d� I
Compressor
Insulation
lb���
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
b/�� _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_
/�� (�t�
Encapsulation
Gas Piping
Gas Test/Q�
����,Q•Fv
Appliances
Final
COMMENTS:
Final
J�
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)
�/ _ �/
h19
_.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._.._60 ft. ... ._.._...............................................................................................................
IN
7' Round Spa Raised 12"
Salt Concrete Decking
Job
Specifications
r
Pool Area
` 310
Pool Perimeter
ry �iD� -5,�56rilkeff—
Shallow Depth
Deep Depth
Spa Area
38
Spa Perimeter
22
Face Tile
Coping
Deck Area
1336
Deck Perimeter
340
Patio Area
Pool to Equip
Spa to Equip
Rich Parzinsky's Pool Construction #431055 Designed by: Gary Midrod
P.O. Box 897 Phone: (760) 324-5827 Steve P. Designed 57-490 Black Diamond
Palm Springs CA 92263 Fax: (760) 324-7287 6/26/2003 for: LQ CA
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification:
Occupancy Group:
SINGLE FAMILY DWELLING
R-3
57-490 BLACK DIAMOND
Type of Construction: VN
Owner of Building: ASHBROOK DEV COMP
Building Official
Bldg. Permit No.: 0105-065
Land Use Zone: RL
Address: 5140 AVENIDA ENCINAS
City: CARLSBAD, CA 92008
By: DANIEL P. CRAWFORD JR.
Date: 3/20/03
POST IN A CONSPICUOUS PLACE