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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.
if6inse # Lic. Class Exp. Date
��-%%74'121 A h 3'Ii�3
Date` ,Signature of Contracto d e
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 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.
STA'M FIND 1242679-97
(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' compensati n provisions of Section 3700.of the Labor
Code,,Vshall forthwith comply wit those pro isions.
Date^ Applicant .iii. - `-�!�^l
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), �. %� f Date
/ PERMIT PERMIT# CONTROL#
BUILDING
DATE %f, /'yr VALUATION LOT 9801-125 TRACT 6542.
$17,679.00
JOB SITE APN
ADDRESS
78-6SS C'ABR1IAD WAY
OWNER
KRUNIM
79-a88 CABRILL(a WAY
LA QUINTA, CA 92253
USE OF PERMIT
POOL AND SPA ONLY
POOL ANDIOR SPA.
CONTRACTOR / DESIGNER / ENGINEER
STEVE DODSON CONSTRU(- rION
73-011 COUNTRY CLUB DRJ VE, S'TE. F4
PA.LNI ESERT CA 92260
(760Y346-4032 CBL# 1044
3x
S
291998
17;67-9,00 f -
d8TY®FLn OUNTA
us"I imATE D COST OF CONSTRUCTION
FEMIT`f F&C SUMMARY
PLAN CHFC1C I:FIE, 101.-000.139-318$1' x.85
CONSTRUC FION FEE 101-000-418-000 $189.00
N-IL-C.HAN.1t';tiL FE1% POC)1. . 101-000-4214-000 $21.00
FIL ECl"RIC:A( Fes: -- POOL 10,1-000-420-000
1TIL14IRINO FFE -- PCM. 10.1-000-419-000 $27.00
SUB-40TA.L CONS'1R.UC'1IORAIND PLAN CHECK
LESS PRk-PAIL t1XS
TOTA'L PERMIT iELS DE1± Now
RECEIPT DATE By i I DATE.FIN LED „� INSPECTOR
V, 107.85
$0.00
5407:83
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
01 -491
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
2..
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:
%� �/� f/ ry. S
No or S
U!✓ ��cLC
1 ��r� r/�"
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 (Penn)
- 30" BOULDERS T.B_S_
1
ADD 30"------� I I``.-, `` DRAIN
GARDEN I I �' / :: �I��`.4,��,i------•---;
WALL S D C I /
- COLORED SMOOTH 12" BAND
- R6'-0" r
X
DRAIN j
••��-�•�•�� �-•-,.�- ..,. ,` ` BOX '
11'6" 12'8"
16'
TO MATCH �.m 9'-9"
EXISTING I I / - `12' 8"
II
138"
II
II
II
EXISTING
WALL AT ----c-
6'-0'
P
RESIDENCE
5'8"
12' !
23'6"
I
P/A
DR/AIN
v
24' 9"
LIGHT SWITCH
"O ----EQ BLIND
S.D.0
LL
a
� M 1
L 11 TA
BUILDING & SAFE-- 1"Y DE." it ), ENT
ACCEPTED FOr �<��`�� ..�. ��. 'd ON
UBJEC ► a ': ° :' TI(D ;PER
BOB CAT ACCESS
Af�D ALL APP L 0"ABLE C DES
J/&i--Br
ADD 30"
GARDEN
WALL S.D.0
TO MATCH
EXISTING
CONTRACTOR cannot assume responsibility for
damage to curbs, sidewalks, driv_ eways, cement
slabs, sewers, lawns, r es, fences, retaining,
� a s, sprin I r , telephone lines or shrubs.
When access is made through a neighbor's
PLO- perty it is understood that you, the owner,
have that neighbor's permission and assume full
responsibility
DATE ----- si(4nature
NEW COLORED SALT• DECKING WITH 12" SMOOTH 13AND
S_D.BUFF
NOTE: LANDSCAPE AND FURNITURE
ARE SHOWN FOR ILLUSTRATION
ONLY AND ARE NOT INCLUDED.
GENERAL SPECIFICATIONS
SIZE 14 X 28
%REA 348 - PERIMETER 77
TILE CHOICEGROUP 3 so.
RBB. NO
(-nPINC; CANT (COLORED)
PUMP CAPACITY 100 GPM
MOTOR HP ST_A, RITF HP 1 -5
MOTOR HP HP
FILTER STA RITE 300 SQ FT
FILTER RATE lo? GPM
HFATFR I AARC S17F 250 RTI I
SUCTION LINES 2 "
RETURN LINES 2-1.5 "
SKIMMER MODEL AM
CHECK VALVE YES-
GASLINE BY S -D.0 FT. 140'
POOL LIGHT 400 W CLOCK
ELECTRICAL BY.S.D.0 FT -200
AUTO CLEANER NO
CHEM, FEEDER NO
PLASTER COLOR WHITE
DECK BY S.D.0 SQ. 995
DECK TYPE
STEP FT.
SPA SPECS.
SIZE 7 RAISED
LITE 100 WATTS
TRI LEVEL SEATS 22" 24".27"
DESIGNER DAMWALL 6 " XI 0' FT.
DAMWALL TOP TIL F"
SPILLWAY SIZE 3 " X 1 8" WIDE
DATE SELLWAY X OPEN CLOSED
# JETS 4 UPER LOWER
1-20-97
Name: MR&MRS KRUMM
Address� 78-688 CABRILLO WAY
My: LA QUINTA
ACT RANCH LQ LOT# 45
poo/s
PALM DESERT TEMECULA
73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. STE 206
92.260 TEMECULA CA.
-(619) 346-4032 92590
(909)676 -SWIM
LIC # A-574127