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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing w&..Section 7000) of Division 3 of the Business and
Professionals Code, grid my License is in full force and effect.
Licegs'e # Lic. Class Exp. Date
�/ ?74127 A WA1
way
vDate ' / • Signature of Contractor ( ;V * —
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
S 'tion 3700 f the. Labor Code, for the performance of the work .for which this
permit is`issuec any 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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provislons.—
Veate: r>" i �•` l Applicant____m k 0• .� l J
,;
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 b"live-mentioned property/for inspection purposs.
Si nature (Owner/Agent1 / Date7.
7
BUILDING PERMIT PERMITy�at,y CONTROL# 4n/
DATE VALUATION SI1d1(1A.00 LOT -TRACT `�
JOB SITE 45.020 B 1UGKI"FE WAY
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENTURY HOMES
sit, VP DODSON (1.0MMU('F ON
1331 SU. 1) MEET
69R03A PEREZ RD. #E9
SAN HERN ('A 92,110)i
('A'FHEnRAL CrFY VA 422�A4
0091191-6007
(619:024-1232 C13I,# 10,14
USE OF PERMIT
P(X)J, AN I)I(JR tiNA
P('KN. AND SPA I)NLY
ESTIMATED C(BS'1' 0 CONSTRtl(A'1ON
11,00.4m
PLAN e' WCK FVX 101-000-4311 1 K S81911
_)NSTRUC t'IGN FET- lot 4Q0-116.000 $126 (H)
MECHANICAL 1:I41i -- i✓c.o%A. 100 -2X;0 -421-W) Sld.W
�
fii.i:0I'RfCAf. i-*Cr.f-: -- Pert.. 1014Ut1(i-4.10-M) S45.00
1 IAMISINO 04. - 1'( ic)L 10100-419-M) $27 rir!
x
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a � �
C
SUB=1UML COWIMWICi'ION AND PLAN CHECK
S30190
LESS PRE -PAID FEES
20.00
`I0FAI.PERM IT 1' E S 0111- NOW
S i+113.Rti
RECEIPT
DATE
BY
D NALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Stee;
Combustion Air
Roof Deck
Exhaust Fans
A to Wrap
F.A.U. .
timing
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 at
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:
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)
71 -On
2- FAN SPRAY FOUNTAIN .
\ c- R6'-0"
,1
r
r
f
17' _ 12" RAISED BEAM
/ I
3' - 6" 'RAISED BEAM
R5'-0" /
10' -8" i
91-811 \
\� 1 181-0"
6'-61 .. �Q
® 21'-0"
PLANTER
�— 11'-0
W_. w
R7'-0"
i
f
3'
7' SPA
y1 p
z f
I
I
C1
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Y F LA WIN TA �
li
& SAFETY DEPARTMENT
T
CONDITIONALLY
responsibility for damage to
curbs, sidewalks, driveways,
cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
-
SPA SPECS..`: - -
GENERAL- SPEC IFICATIONS•
"
SIZE 7
RAISED 0 11
LITE 100 WATTS
TRI LEVEL SEATS
22" 24" 27"
DAMWALL.WIDTH 6
SPILLWAY SIZE 3 X 12'
SPILLWAY
OPEN III F CLOSED
#JETS 4
SIZE 14 X 28 AREA
346
DEPTH 3' 5' 3'
SHAPE PERIMETER
79
TILE SIZE 3X3
TILE COLOR
COPING CANTILEVER
COPING COLOR
POOL CAPACITY
GALS
PUMP CAPACITY
GPM
MOTOR HP STA RITE 1
HP
FILTER STA RITE 200
SQ FT
FILTER RATE GPM
TURNOVER HRS
SUCTION LINES 2
"
RETURN LINES 2-1.5 "
MAIN DRAIN - 2
"
SKIMMER MODEL AM
CHECK VALVE
HEATER LAARS SIZE -- BTU
GASLINE BY
POOL LIGHT 400 W
SPA LIGHT 100 W.
CLOCK 220 V
ELECTRIC BY SDC
ELECTRICAL BONDING BY: SDC
TILE AND COPING
DECKING BY SDC
CONTRACTOR cannot assume
C1
Bz,. ILDI9ii
Y F LA WIN TA �
li
& SAFETY DEPARTMENT
T
CONDITIONALLY
responsibility for damage to
curbs, sidewalks, driveways,
cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
ACC
SU
PTSD POR ZONSTRUCTION
ECT TO INSTALLATION AS PER
or shrubs. When. access is made
through a neighbor's property it is
understood that you the owner
1 1
DESIGNER have that neighbor's permission
.fl and assume full responsibility.
4D ALL APPLICABLE CODE
p / Name: CENTURY HOMES
/ lO. BY _z 45-020 BRIDGETTE WAY
address.
j� LA QUINTA
TRACT 26188 LOT# 2
®® sol,
= .
A00/s
_ SHOW ROOM
73-011 COUNTRY CLUB DR. STE. F-4
PALM DESERT CA. 92260
PHONE (619) 346-4032
LIC # A-574127