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LICENSED CONTRACTOR -DECLARATION
I hereby affirm under penalty of perju;;%that I ;yam 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`f6i6&'6hd effect.
License # - Lic..Class Exp. Date
$i31 OSS °' sJ°1dt33
Date A4 Qi nature 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
SKon 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�aT�e'f4� I i1`It.;� Policy No. D461044702
(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 with those provisions.
Date .lApplicant—
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
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agerit� lDate -4 ` D
BUILDING PERMIT _w PERMIT#
DATE [%1 VALUATION LOTTRACT
JOB SITE'
APN
ADDRESS 15&,9� A gMZff
OWNER
CONTRACTOR/DESIGNER/EN (NEER
NMALYN CL"X
MCWYRE SPOOLS & SPAS
55•$23 D*Att1:3'17TtN •
P.O, BOSS 1791
LA QUIlTrA CA X9753
1:,AQiG"'lg.'IN CA. (22s,
CrBff 1945
USE OF PERMIT
POOL ANWOR. SPA
f?001,, xPA,'WA,TfffZVi±JLTUW?. AW=114Alt#IMUS 3k1.1%L1, BF, 04
AT PRE PLAS TiF..)Y;; INSPECTION, FOITIPMANT FN-0XJ8URF;NOT FNCLUUED
POOL ANDIOR. SRA 149
9U '. I'm C05T OF CONi M. UCM011
PMN4xjr We SUMMARY
PIAN CHEVX YISL' 301-000-439-318 $105,30
C;.ONSTRUC31CYN FIFIX 101-000-4. 16 -OW $162.60
MW-HANICAL ME -- POOL 101-000-421 -000 $24,00
U1.wC'r. IdrCX, '?ZZ -„ PCXX 101 -000 -420 -faun $45.00
I°IxIMI DIW-0 Fu ,: POoL 1111.000419.000 VIM
•D
Ow L
CITY OF LA QUINTA
FINANCE DEPT-
$363.30
IMM Me -PAM FM
WIM
z T4VULP A^1�.I;'1:='1? % DUN N0W
'u' (543.3
RECEIPT
DATE
By 0`�
DATE fINALE
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
i' Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
= Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
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)
/Of
Final �3
COMMENTS:
FITTTTI-P11,
--A -RE INSPEtTI.ON' FE OF $30 CITY OF LA QUINTA
BE CHARGED I.F. APPROVED BUILDING & SAFET�( DEPT.
PLANS-AND)OB CARD ARE NOT ON APPROVED
TH€ ..ITE, FOR A SCHEDULED
FOR CONSTRUCTION
INSPECTION,
NO'EXCEPTIONS! ` . 10 Zy
i. .
NOTE; All existing irrigation and landscape to be
repaired as necessary at cornpletion of construction
r•
./- 34' TO P/L
P
SKIMME
/L I NEW DE I W AREA
ExISTIN6 PALMS
FAIRWAY
/ 4
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i
�existingts to be rplae5 OMIN.planted after c
wa,Kt�n 4 w x 3a•n x 3•e
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wdsting fi i.
ater'Drawn b20/02
. i • O Drawn by—Tom
SPECIFICATIONS
Pool Size..... 15' X 24'
Spa Size..... 6' X 11'
Pool Area... 365 sq.ft.
Spa Area ... 50 sq.ft.
Pool rimeter... 94 ft.
°"si' r °" erimeter.... 30 ft.
Pool Depth 3' 0" X 5'0"
Spa- Eleva...+0"
Spa Jets .... 4 UPPER 2 LOWER
Lights. -1,400 1,100
A utof ill ... M . P . Products
EQUIPMENT
Pump.Pentair W.F... 1.5 H.P.
Pump.Pentair W.F. 1 N.P.
Filter... Pentair CC420
Heater Teledyne Laars.EPL400
Timer ... JANDY AQUASWITCH
Decking color... SanD7-sayttv Buff
Square feet .... 300
Tile Choice ... GROUP 3 T.B.S.
PEBBLE - COLOR T.B.S.
Madalyn Clark
55-823 . Braebum
La Quints
SCALE: .1/8" — 1,_0".