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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.
Licenser#"' Lic. Class Exp. Date
Date % Signature of Contra' torts
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
„r
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.
,,x)11 have and will maintain workers' compensation insurance, as required by
ection 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 Policy No.
M ni7�
(This scoTie�b2be com leted if the ermit valuati or$1�0
0.00 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 tt ose-peevisi no s.%..,
Date: Applicant ° - —
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees._
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on -his
application.
1. Each person upon whose behalf this application is made & each person at,
whose request and for whose benefit work is performed under or pursuant to',
any permit issued as a result of this applicaton agrees to, & shall, indemnify%
& hold harmless the City of La Quinta; its officers, agents and employees.
2. Any permit issued as a result of -this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authoriz�epresentatives of this City to enter upon
thy.aliove-mentioned'property. foi"Inspection purposes._ e'
Signature (Owner/Agt) ✓ Date --;2 t 7'
��rrG.r� ®.r ��.�.sY� ss�fsW"uraf � •'far• rw_ard �LJe.
BUILDING PERMIT PERMIT# °°NTR°`�
5457
DATE VALUATION LOT 97117-024 TRACT
JOB SITE
ADDRESS
APN
AA -A" 1% (1 AZI ItA'.
na_ 911 iixll
OWNER
CONTRACTOR/DESIGNER/ENGINEER
REYNOLDS
STEVE DODSON CONSTRUCTION
414395 CADf INO AWL
73.011 COUNTRY CLUB DRIVE, 3`TE C4
LA QIIWA CA 92253
PALM DESERT CA 92260
(760):446-4032 CBL$ 1044
USE OF PERMIT
PCKA. AND SPA ONLY
POOL ANDIOR .SP.A. 15,669.00 'L$
ESTIMATED ( OST Ok' CONS'.1('RUC ION
15,669.00
laERMfT FEE SUMMARY
PLAN C;HFC—K FEE 101-000-4139-31.8 i1 i l.13
CONST'RUC110141 .101-000418-000 • $171.00
to.w, lrll`fmAf.:-'P,E •- Pooj.. foi- -121.-000 $24.00
HIA x."1`RIC AL Vh1t -... {irk).. 1014KI10.420-0018 .'0. 9.00
PLUMBING FEE =- POOL 101-000-419-000 527.00
r CONSTRUCTION AND PLAN CRECi;
$378.'14
-LESS Ptak -PAID FEES
$0.00
� .>�F.FI11fIT F'F,1+;.5 DUfe,NOW
537&15
C. -
RECEIPT
DATE f
BY
DATE FINALED.
INSPECTOR
b
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
BLOCKWALL APPROVALS
steel
POOLS - SPA
Set Backs
Electric Bond
—777-177
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
1 44'1
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:
Of
air pipe
j -box
3'
M
Construction Notes
No H.O.A. approval
necessary
access thru door
rock to be placed in deck
prior to pour
p/I
N
GENERAL SPECIFICATIONS
SIZE 15 X 3.0
AREA 320 PERIMETER 77.5
DEPTH 3x5
TILE CHOICE group 3 S .60
RBB. 20' C 6" 1210 12'-
COPING
2"COPING cantilever
MOTOR HP STA RITE
HP 1 .5
MOTOR HP n/a
HP
FILTER STA RITE
300
SQ FT
FILTER RATE
103
GPM
HEATER LAARS SIZE
250
BTU
TURNOVER
2
HRS
SUCTION LINES
2
RETURN LINES
2-1.5
"
SKIMMER MODELAM
"
GASLINE BY sdc FT -45
POOL LIGHT 400 CLOCK t 104 r
ELECTRICAL BY. sdc Fr. 180
AUTO CLEANER n/a
CHEM. FEEDER n/a
PI ASTFR COI op White
DECK BY sdc SQ. 792
STEP 18' FT.
SPA SPECS.
SIZE 7' RAISED +12"
LITE 1 WATTS 100
RI LEVEL SEATS 22" 24" 27"
DAMWALLI 2 " X 6 FT.
DESIGNER DAMWALL TOP rock/tile
randy SPILLWAY SIZE 3 "X 12 " WI[
SPILLWAY x OPEN CLOSE
DATE #JETS 4 UPER LOWI
6-23-97
Name: Bernard and Cindy Reynolds
Address: 44-395 Camino Azul
La Quinta
CII)
TRACT Ranc. Ocotillo LOT#
Paw
�O ALM DESERT TEMECULA
73-011 COUNTRY 28910 RAND
CLUB DR. STE F-4 CALIFORNIP
PALM DESERT CA. STE 206
E 92260 TEMECULA
92590
BION (619) 346-4032 909 676
ONLY AND ARE NOT INCLUDED. LIC # A-574127
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