0205-060 (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,
Datef
C51 Mc f 0120
Date ?r'' Signature of Contractor
f/ OWNER -BUILDER DECLARATION `9rr
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.
Q7i 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 S'Fl•4 -9 Policy No. lafto
(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, apd' agree that if I„should become
subject to the workers' compensation provisions'of Section3700 of the Labor
Code, I shall.forthwith comply with those;provjsions.? 1-,
Dater%/.11�,A P'APPlicant'G';'”-��'".a;v 1
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-represeniatives..df`this City to enter upon
the above- mentioned •property for inspection purpose§ s.,
Signature (Owner/Agent)'. �~' Dates•+; '
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1
BUILDING PERMIT
DATE OW -3/70V VALUATION � LOT
JOB SITE
ADDRESS�pia�i�4i�
OWNER
FRANK t & ZO IyMCg
%
44.185 CA11s YNO.,<tWL
LA Q�TINTA. . CA 9053
USE OF PERMIT
POOL AND/Olt 811A
0-P,EBMP;#
TRACT
APN
CONTRACTOR/DESIGNER/EN (NEER
S..t¢,t,WE V ,iki. A A"4.+a•7A.S€ :114C.
70-,180 rMIZIDER
]KANCSO MMAGE CA M-11170
(7o)cm-ow C214f 3735
-1
P+00L.1k SPA ON£.,Tr A AAMS AARP1 i US' 4HAIJ, BE IN MACT, M., M
1f OOK, :-kNIXQ VA
3s,rmoo Le,
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1-.g$7�/.•sR�..V�d�IP/�/Py�}�Y.i�l'y.' 1,y'��A�r!.y�I�dYliB6Y:'i..7k
tlA.Yll, Lr.Ki.b1.+6.1.A' m %L5i 7.'6d'f.i61'-"•t,Y w3 ,7 • ♦ /�41C\,.M
161 -WO -41&,000 S7330
W0WWAJ. MIR pwfl 1,014V-4.21,400
AND -
000 $45,01►
.PLR'.fhk.�3�hFt� M — 1 9-M
MAY U 3 2002
' CJTYOFLAQUINTA
FINANCEDEPT.
351=10
RECEIPT DATES BY DA F E INSPECTOR
r.
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
0. 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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
7P
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
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)
COMMENTS:
N
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1
CAL -NEVADA
POOLS
MARK TOW
70180 TtRJNDER ROAD
RANCHO MIRAGE, CA. 92270
PH 8310860
LIC. p 777601
1 /.moi
I
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�4'
Designed by
KERRY R. KOEHNLEIN
PHONE 360-0012
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COO
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
m�Ftc(F
VICINITY MAP
91
OWNER to fence pool area and install self closing and self latching gates per code.
NOTE: No dirt will be removed, returned or graded after day of excavation.
NOTE: Relocation of equipment pad will result in additional cost to owner.
NOTE Fill pool immediately after plaster (follow instructions). Oo not use rubber hose.
NOTE: Do not tum on pool light when pool is empty.
NOTE: Wet down concrete shell at least twice daily for seven days after shell is installed.
�rS*q� I have reviewed this plan and hereby approve t I plan b specifications.
sem- DATE IL
CUSTOMER SIGNATURE
POOLSIZE � ( _ x 3-1 Depthx�g )(31
Surface Area 41. 1`'
Perimeter
EXCAVATION Access
Gradina f' '
Dig From
Obstacles w±Q0-
Walls Removed Vt.1
D
Replaced ` le'L
�I
Misc.—�4
lS
ta-c -,TeT3
PLUMBING Finer-X*C-Z.i. ,,
Size 3 Oa
Pump ` 4 u .it st,1:�[%.
Booster Pump /uJ
Skim Run 40. Drain
Ret 3
FII line 14 v'T% .. —Purifier AUTO
Auto Cleaner [ O # i g
P t—A /J
HtrType iiae <61< 0••4�.
GasL/F _
FOUNTAINS -SPRAY HOS—WATER EFFECTS
Type' JDt ia, wr*=riFt rti 9
Size
Plumbing Length = ;>
Valves
Booster Yes' Type '.
Sae
misc.—
STEEL GUNITE Eng
Sur -charge _tpoty
s' RBB 12'-__j L 1s'
24•_
Step Risers
Spa Wall Width
Benches
Love Seats t
Spa Dam Wall
Notch .3
Misc.
ELECTRIC Total Run L/F ".SO
Fiber Optic
Remote � S ---4—
Spa 4 8u'Ttay
misc. - ju a
TILE wtinei tfio9
Coping ►J J
Step b Bench rile o q►
Misc.—Ghss —Ltc. N'
DECKING Sq Ft g0 ' Type $4►� Color 7"O
Nat Concrete Sq FL_.n_ Cantilever
D.O.D.L/F Step Risers
Misc.
_ ..
SPA size___7 OC`t' Area
L *
Per -j±
PumpBlower_
Z kO
Spillway_ 3
Jets jStep
LighWO-0
Misc. f s:ao r lr 7 rS_rrx r,.5 e
ta-c -,TeT3
INTERIOR FINISH .2. M1.
Color -'6
&
otherA (5 -M C - y 3 T' /»
p r A3 P
IZ AI NS
A 3 51-k D w AJ 0 A.+
P t—A /J
!w$Uae ,P-oc-L Te
25ai'.5'C7i
,
OWNER Fk A n.sit 2 /C-9 L 1'Lg
ADDRESS 414 Vq-6 CAt4fivp Z 4JL'
CITY A' .. i SOLO BY 0 DATE
PHONE (H)_fl
DRAWN BY DATE - .� t v'