9710-166 (BLCK)LICENSED CONTRACTOR DECLARATION
r I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W '` Professionals Code, and my License is in full force and effect.
MLicense # Lic. Class Exp. Date .
~ Z I --Date C Signature of Contractor
00� ,�1i•v`
Cp OWNER -BUILDER DECLARATION
J
lL W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
co ~ 13_ License Law for the following reason: F
Z_ I ( ) 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).
C'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
CL Q WORKER'S COMPENSATION DECLARATION
p 2z I hereby affirm under penalty of perjury one of the following declarations:
LO 0 ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W LL• compensation, as provided for by Section 3700 of the Labor Code, for the
00� Q performance of the work for which this permit is issued.
100 Q U (,. I have and will maintain workers' compensation insurance, as required by
Q U Q Se tion 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
� Z Carrier Policy No. 7
CIS —) Or.
l't L,S ki 1' UkYI� 11'x✓
w ,
J (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,
4 1 shall not employ any person in any manner so as to become subject to the
Workers' compensation laws of Cali forst ia, and agree that if I should become
1 subject to the workers' compensation provisions of Section 3700 of the Labor
•�•i7 Code, I shall forthwith comply withose provisions.
ate: /on Applicant J9l
Warning: Failure to secure Workers' Compensatio J 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 proper, �fo'r inspection purposes. ^•}�
1 signature (Owner/Agent) f� Date d` 1'%
BUILDING PERMIT
DATE Mitt..%�% VALUATION.f17': LOT
PERMIT # CONTROL #
6220TRACT
-
JOB SITE
ADDRESS 74)-23.5 CAlZ INO ii1�<1:�ii1A APN
OWNER CONTRACTOR / DESIGNER / ENGINEER
i`':�I,..tMi:�i,f`�.i• 1)i�ieaiis y1i:�\A ir��i: �f�� �'�)llt's•�pf �J(lhf."Iii�l7'+'f•�r'trj
7-Z35CA&11NO KOSADA 73.011 C OUNMY CLUB VRJVf-, SM.. V4
l.tt 1,10iNlii (_7 ri y,►#S:i 1>ti1,lli 1)1. S .1c'(' (;A 92246()
0601346-11(1,z'a (1111.tf 10,14
USE OF PERMIT
AJUI DING
43 L.R. 0 6,ARL 0,4 WALL, CFfY S3'FiNi>ARA
fr r s". WMIL
43%.i"n) Lid
�w.�f't�i t IOI�.t A•> }.j1 %i r;4 a i�a �.i+i�� •i �#�i if�i.�li1 AR?i i
!'FRNU ;
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
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
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:
lawn
-- 12'-0
area
T
iA
B
B
Q
P/1
R8'--
existing gas line door
for bbq stubout
GENERAL SPECIFICATIONS
E 16 X 45
AREA PERIMETER
DEPTH
TILE CHOICE S .
RBB.
cut [pool to n1low for COPING
gunite recess seal forV� \ •Z'1POOL CAPACITY GALS
\. use with waterfall ` �,� � PUMP CAPACITY GPM
MOTOR HP STA RITE HP
MOTOR HP HP
�
----- ---------- L
45'-0" -----i -------------
FILTER STA RITE 304 SQ FT
FILTER RATE 103 GPM
` ATER LAARS SIZE BTU
s �
CITY Y OF LA QUIN'
R13* Id"� S CTNELINES 2HRS
"
t£ O
-TURN LINES 2-1.5 "
BUILDING & SAFETY DEPARTMENT S IMMER MODEL AM"
CONDITIONALLY C 4CKVALVE
t
ACCEPTED FOR CONSTRUCTION C ASLINE BY FT.
OL LIGHT 400 CLOCK
�UBJECT TO INSTALLATION AS PER E ECTRICAL BY. _-- T.
j I UTO CLEANER
HEM. FEEDER
--- 30.-0'' i PASTER COLOR
19'-3' t 43'-0' AND ALL APPL!CASLE CODES
ECK BY Q.
4 E P FT. -
�' 0 'Z�' SPA SPECS.
IZE RAISED
LITE i WATTS 100
RI LEVEL SEATS 22" 24" 27"
3 + DAMWALL " X FT.
DESIGNER DAMWALL TOP
25'- 0" SPILLWAY SIZE " X " WIDE
LAWN RANDY
SPILLWAY OPEN CLOSED
AREA DATE # JETS 4 OPER LOWER
6-17-97
Name: NICK PRIMAVERA
Address: 79235 Camino Rosada
ID _ City. La Quinto
s TRACT LOT#
POO/SRESIDENCE - 15'-0---
IW LUF� PALM DESERT TEMECULA
bobcat access thru 73-01 1 -COUNTRY 28910 RANCHO
garage door CLUB DR. STE F74 CALIFORNIA RD.
SCOIe: "a 1 E PALM DESERT CA. STE 20r
TEMECULo% CA.
NOTE: LANDSCAPE AND FURNITURE 92260 92594 t'
ARE SHOWN FOR ILLUSTRATION (6 19) 346-4032 (909)676 -SWIM
I ONLY AND ARE NOT INCLUDED.
LIC : A-574127 •,' •
1