0212-032 (RPL)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
f x656128 C531~�t. .S � 1 " J a ltd
Date `�` "^`�' Signature of Contractor i y«
OWNER -BUILDER DECLARATION
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 o'f 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.
'(ji) 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 STATE COMMSATI Policy No. 041600610-02
(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 wif those provisions
Date: -� •�1 Applicant s ,Zpv:,"'"''
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 applicator 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 representatives of this City to enter upon
the above-mentioned DropertwfOG inspection purposes. e ' e
,Signature (Owner/Agent) 9y', Date •/ 2_ -7 -
"BUILDING PERMIT PERMIT#
.h
02VI-032
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS1L:i.D1,.AX()I:
.r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Q3 A I
_
Main Drain
Bond Beam
Q4z
Approval to Cover
Equipment Location
Underground Electric
u
_
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
Final
Utility Notice (Perm)
,rSEia SPA 'S t2:° �..�IT44 5MOicrf A CO GetP
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E Kt :f>Ti n116 tAJALL-
SPECIFICATIONS
TYPE C'. Ll1 fi !
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SIZE `t 7 X I -
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SURFACE AREA OF POOL
C� f r,
DEPTHS MIN. MAX.
PERIMETER _ _��
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4
SPA SPECIFICATIONS
TILE
SIZE _ X --�} SO. FT.
TILE TYPE
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SPA DAM WALL WIDTH e
WATER LINE
TILE TRIM
B a0
NO. OF JETS
r X
2
LIGHT / OLJCs
QUARTER ROUND
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RAISED SPA AT i__
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SPILLWAY TYPE >
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SPECIAL NOTES -
_
DECKING _
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EXCAVATION STEEL
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FINISH
TYPE si'e _
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EXPANSION JOINTS -'
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ACCESS FROM
CANTILEVER K 7K*-'
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ELEVA71flN
DECK DRAINS
DEEP LND RAMP
LOVE SEAT '' �_
0ECC0 DRAIN
CONCRETE REMOVAL r.2 ifY' LOADS
CUIRb CORE
SOD REMOVAL. LOADS
y
STEPS
TREE REMOVAL BY i
STEP FACE r
IRRIGATION REMOVAL
TILE SASE
IRRIGATION REPAIR
SAND AND VISQUEtN
y
a
6` R.B.B. -
RISSCINS ",
E
12' R.B.B. -5P14
MOP STRIP - —
IB' R.B.8, '
24' R.B.B.
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30" R.R.$.
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TAN SHED DEPTH Y
N1ASONRY
a
ROCK POCKETS -
t lx-INt TYPE
e
9 �
CENTERS
_ s
R.B.B- FACING -`
SPILLWAY TYPE1'„�3' E'-._ SZE
sTISPS
I
---
PLUMBING
t
FILT13R W A SIZE
PRCP- EXT. WALLS
I
POOL PUT#P kYh&.SIZE l5 i!!'
PLANTER ^LL
� s
RETAKING (MALLS
BOOSTER PUMP SZE
EQUIP. WALL5 � � `�
y
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ADD'L PUMP SIZE
F}R�FIT
j
ADD Pt�la1P SIZE
HEATER �I� s SIZE
TIME CLOCK 11&2Y eMera sr biro;
SUB PANEL
ADO'L OUn FTC
SKIMMER TYPE ( e,
FILL LINE 4A-_
I ER
PEBBLE PLAS LAST
,�� _
GAS LINE _ r"4 r STUBS
uWTS POOL
LIGHTS SPA r dr*!
FOUNTAINS/SPRAYHEADS _-
ROLLED BOMD BEAM
BEHIND SPA
SHEER DESCENTS
EYEBALLS
LIGHTS IN POOL 1. IN SPA
FENCING -
STUB SET EQUIPMENT_ 4 a ? �' •
MISC.
dr
FENCE TYPE
�
PLUMBING SZfi �2C-7"/4"
HEIGHT
GAPE
GU N I TE
GATE REVERSAL
REMOVE do REHANG"
DEEP END RAMP
EXTENDED 2nd STEP-
LOVF9EAT � X
C'
4PII (.WAY T'eP.E_�� �'�—
EST START AV . �.
CANTILEVER
rF _.
OTHER
COPING _
R.B.B. -SEE STEEL -
LI I S
I
CONSTRUCTION AUTHORIZATIdN
1 Sid hES FIELD
IMG
PRE-G t. UN iTI;
UNI)I:RIGROUND
MASONRY - -
])LCK
OMrfiR TO: (1) DETERMINE THE APPROXIMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY OF EXCAVATION
(1) TAKE NOTICE THAT POOL AMD EGLAPMENT LOCATIONS ARE SUBJECT TO ACCEPTANCE OF
LOCAL BUILDING DEPARTMENT AT TIME OF ISSUANCt OF PERMIT
(3) WET DOWN CONCRETE SHELL AT LEAST TWICE DAILY FOR $EVEN DAYS AFTER SHELL IS INSTALLED
(4) AGREE THAT CALIFORNIA POOLS IS NOT RESPONSIOLE FOR UNDERGROUND CONDITIONS OR OBJECTS,
AND ANY DAMAGE TO CURBS, SDE'AALKS, DRIVEWAYS, LA*S. OR OTHER ITEMS IN THE ACCESS AREA
(6) SEE THAT ALL FENCING, GATES, AHD GARAGE DOL MEET LOCAL 00DE3 FOR A POOL ENCLOSURE
PRIOR TO PREPL.ASTER INSPECTION
St RUBBER HOSE)
(A) FILL POOL IMMEDIATELY AFTER PLAWI (FOLLOW INSTRUvfP-"0 -- DO NOT U
FORMA POOLS AND 1HAT ANY
(i) TAKE NOTICE THAT THIS OF1A914NG IS .THE SOLE PROPERTY OF GAI1
USE WITHOUT WRITTEN PERMISSION OF CALIFORNIA POOLS, INC. IS PRONDTED BY LAW.
OMER APPROVtS PLAN, POOL, AND EQUIPMENT LOCATIONS AND HAS READ THE RESPONSOLITIES AND N0110ES A9OVE.
31r,NATU E (5) - DA
TE
SWIMMING POOL PLAN FOR:
NAME R RESIDEklICE14
STREET
C - �IrITY A
JOB ADDRE.,S
PHONE OFFICE
LOT '1 TRACT
MAP BOOK PAGE NO.
MAIL ADDRESS _ --
CONSTRUCTiON OFFICE PH
SCALE DATE
1/8 "=l I I 42 0 ,,
JOB#
1
2
13
S
RES
PAGE
N BY SbLO BY
it ,
VISIONS
SELECTIONS
CHECKED BY
DATE
STONE
' f,
TI LE
}
I
BOULDERS
r
DECK COLOR
PEBB./'PLAS
SIGNATURE
DRAINAGE NOTE. Drainage and irrigation for punter's and pots, by
others. unless other vise noted. .
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PRt-PEBBI.I: