603-067 (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`oF411 i Lic. Class Exp. Dated;-)}
Date J '' 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 Sfk0 F ti Lab -'or Code, for the performance of thelaorl iON which this
permit is issued. My 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 thopeprovlons.
Date: `4-2 0 - YZ Applicant 14'd ;AA--
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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/Agent) Date
»,;c/9J3UILDINGIRjE,R, M11 PERMIT%Q��j,{.�j(�% CONTROL#
DATE VALUATION LOT TRACT 2955
JOB SITE APN
ADDRESS
OWNER CONTRACTORID SIGNER/ENGINEER
KAN( III t 00 rl'11,l.t) 1.1' I I:1' : f.rt r1):,t;rt c. t.)NMRI K-i1(?r:
;.i27 , Ct MINu bE1, Oki-) it") PEREZ M) tiE9
I.A Q1.11N_rA ('A 422SA (.'A'1'1IHI)KA1, ('tCY ('A 922XI
(41113),424•1212 (-'RLH 10-!•1
USE OF PERMIT, K A, ANI POK *SPA
ANim-)k *,41A I I JVXAJ 4xt LS
lL:STIM.e\'UM COST OF LU;+ STRUC: i ON
I<'ICRmn, 1~ here sC mm,%Rv
iLANC:IIEC: FEW 101400-430 318 SI()93ll)
w1FCHANICAL Fix POOL 141.000-4211.000 S24.(k.)
nii'(-MICA1. i,fs'ls -- P001. 1014000-420-000 $4 5.W
t-'l,tiNI"INCT HEF. -- Inc A. 101-000-419-0{10 527.00
1-0NSTRUr"I't0N I; FTi 101-000-418-000 S162.00
SUB-TCYrAL C;ONSTRUCi1UN ANI? PLAN CHECK
LESS PRE -PAID FEES
TOTAL PFRNIIT P EF -S OUK NOW
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
1 S,").oa
$363.30
$000
$353.30
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:
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)
P.L.
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RAF 11 9 1
5'+
43' W.I. FENCE
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4FT TALL
W/GATE AT PATIO
:.
4'6"R
50'+
16'6„
4 EXISTING._.._ _.._ ', DIA '
PATIO POSTS .I SPA
EM Im
33'4'/
GATE
W
DECK IS
18" WIDE MIN.
20
„
,6 12'
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POOL & SPA
LIGHT SWITCHES
250
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RAF 11 9 1
5'+
43' W.I. FENCE
' � I
4FT TALL
W/GATE AT PATIO
:.
4'6"R
50'+
16'6„
4 EXISTING._.._ _.._ ', DIA '
PATIO POSTS .I SPA
EM Im
33'4'/
GATE
W
DECK IS
18" WIDE MIN.
20
„
,6 12'
W �
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W S
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.�
POOL & SPA
LIGHT SWITCHES
250
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CITY OF LIIA QUIN I A
BU1-LQj,NG . SAFETY DEPARTMENT
y : ...: ; .
} - : m,r OAMTPUCTION
ALL AppILIGIME CODESBy
SPA SPECS. GENERAL SPECIFICATIONS
SIZE 7' DIA. 23'PX39SQFT I SIZE 14 X 28 AREA 318
RAISED DEPTH -316" TO -5'6"
LITE 100 WATTS SHAPE CUSTPERIMETER 75
TRI LEVEL SEATS yES TILE SIZE GROUP 3
22" 24" 27" TILE COLOR SF 36
DAMWALL WIDTH 6"X7'. RAISE BEAM NOT
SPILLWAY SIZE 12" X " COPING CANTILEVER 86'
OPEN XX_.CLOSED POOL CAPACITY 10770 GALS
PUMP CAPACITY 90 GPM
JETS.# 4 MOTOR HP STA MAX 2 HP 1
FILTER SYSTEM 3 -. 300 SQ FT
FILTER RATE 100 GPM
TURNOVER 2 HRS
RETURN LINES. YES "
MAIN DRAIN YES
SKIMMER MODEL DUAL PORT
CHECK VA'LVENO
HEATER PUREX SIZE 250,000 BTU
GASLINE BY S.D.C. 46'
POOL LIGHT 40OW
SPA LIGHT100W
CLOCK 24HR 220V
ELECTRIC BY- S.D.C. 147'
ELECTRICAL BONDING BY: S.D.C.
TILE AND COPING S.D.C.
DECKING BY S.D.C. 562 S FT.
NAT/SALT
CONTRACTOR cannot assume
responsibility for damage to
curbs,_sidewalks, driveways,..
cement slabs, sewers,
lawns,trees; fences, retaining
walls, sprinklers, telephone lines
or shrubs. When access is made.
through a neighbor's property it is
understood that you,the owner,
have that neighbor's permission
and assume full responsibility.
Narne7NICHOLSON
AS&B-9-_792.75 Camino del Oro,
max: La Quinta, Ca.
Raancho Ocodllo .
ivWor
D® s0
® 100�
SHOW ROOM
73011 COUNTRY CLUB DR.#F=4,
BOBCAT ACCESS PALM DESERT, CA. 92260
R&R GATE W/WALL. PHONE (619) 346-4032
LIC # A-574127 jeff lamb