0401-017 (RPL)H
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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
SM680 C-53 ,� . II j AatiI/+X
Date ' 1 1/1 "+Signature of Contractor+
OWNER -BUILDER DECLARATION
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 :I'+XEMPT-1 EEI EWDI 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 l should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. .
Date: tj� 1 �1 Applicant i t t i �� .?� t14,
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
tcorrect. 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 inspection1pAurposes.
,,\ '
Signature (Owner/Agent), Date
BUI_LG►1NG PERMIT PERMIT#
DATE VALUATION LOT 0401-017 TRACT
JOB SITE
APN
ADDRESS 37-640 BLACK 1YA AT0YW
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C R.E''GOR
IR +iA.RAk t' P001Z AND AS I
57-(9'0 BIACK DIAMOMP
46880 _M01ft-TT.i IN CC)tiIM11M 0.9
1."' Q - "TA CA 92253
NDU "lr� ' " CA. 92210
Q60)345-1376 CTUi 66577
USE OF PERMIT
F'OO L AtTI' O.R RTA,
YOWSPIa, ALARNISMAT'�� ER,- SHALL Bj: IN PLACE AT PRIF'PLAS TER
INSPECTION. EQUfPME1`T;'L OLOSCIPOTTOT DICLUDE-D
POOLANDIOR WA iRs
X5'i'.�:�"X171 COST O:� CON'w:l a UC.B(ON
151000M)
PLAN CHECK FEE $10.30
CONS TiRt)C'TION FVE 101-000-418-000 $16100
MECHANICAL ME, •- POOL 101.000-421.000 $24.00
FLEC•T..RICAL FEE, -- POOL 101-000-4.20-000 $45.00
PL,UMURKI 1Tilg -- POOL, 101-000419-000 $127.00
�. PUB 'C"Ow.-0LiCi' O14 .F ND A.T.. W M.0I"=CK
`4t
5361.30
L' MUS IME -PAD - S
$0,00
AN 07 200 �� aAx. ���� � � �°��� r���if•
CITY
�
OF LA QUPVT•
J
RECEIPT
DATE j
BY
DATE FINALED
INSPECTOR
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 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:
1'
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)
S?"(040A Y OF LA. QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNER " BUILDER �El��3P-A � ANS i � - xc_
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade / Classification
Contractor
State Contractor's License
Workers Compensation Insurance .:
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C 12)v
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CONCRETE (C-8)
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53 20xCV7f/
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(C-5)
%FRAMING
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STRUCT. STEEL (C-51)
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MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
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DRYWALL (C-9)
HVAC (C-20)
ELECTRICAL IC 101
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ROOFING (C-39)
/
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
�. .�� _
{iv�'yi �� '—
POOL (C-53)
L -S K_ i)
`�� .� J�(,
S li�`I L '�
�A ���
D/
6 as
11 1
SPA +18"
WITH STACKED QUARTZITE
SPILLWAY
UMBRELLA SLEEVE —
TANNING LEDGE —
G/E —�
NOTE:
LANDSCAPE NOT INCLUDED
�— 12" RBB
m
N
5'-0" R
33. .
V-001 R ` G' OF 18"
3'-6" R RBB
.o
-5'
20'-3"
10'-6" I
-316 I.
. PLANTER -
0 6'. 17 .
P/L PLANTER
o. o 0
4' -0" R ^ 'PLANTER
riTER - -
AC
n
P/L
18" WIDE CASCADE
TOTAL CONCRETE
1,204 SF BACKYARD
+523 SF FRONTYARD
TOTAL 1,727 SF
CONCRETE
TY OF LA QUINTA
tILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DL`ry • ` BYdr r
EMBRAND
POOLS & SPAS INC
CA. LIC. 800880 C-53
78-910 VIA VENTANA
TEL (760)'!71-212153
FAX (780) 771-2181
POOL & SPA SPECS
POOL SIZE: 32'X 1316"
POOL AREA: 365 SF
POOL -PER: 2
POOL D • 3' '
PA SIZE: 7' D
SPA AREA: 42 SF
P :2
DECK AREA: 1,204 SF
COLOR: SAN DIEGO BUFF
PUMP: 2 HP
FILTER: 40SF
HEATER: 400 K BTU
CONTROL: JANDY RS 4
CHLOR: A UARITE
CLEANER: NAVIGATOR
PEBBLE: DOLPHIN BLUE
TILE: COBALTO BLUE .
POOL LIGHT: 2-400 W
SPA LIGHT: 1-100 W
RBB:
MISC: SPA SIDE CONTROL
6' OF 18' RBB AS PER
PLAN
18" WIDE CASCADE
GREGORI RESIDENCE
ADDRESS: 57-640 BLACK DIAMOND
CITY: LA QUINTA. PGA WEST
LOT PASADERA
DATE:
SCALE: 1 "=8'
DRAWN- BY8
JOB :