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0009-039 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affi }m under penalty of perjury that I am licensed underprovisions of TChaptIi (commencing with Section 7000) of Division 3 of the Business and ?rofessionals Code, and my License is in full force and effect. 15;,License # Lic. Class Exp. Date 374127 A � ���"" ,, � y��-•-�'` Oal3 1 `fit Datej_�/' Signature of Contractorf� ` ` ',• `—_ �'� 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 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 STA.TF FUND Policy No. 046 -OD -0007934 (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 of the Labor Code, I sh ll'forthwith comply with those�'pro ipions. Date: dvApplicant Z'� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, -indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void'if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property na inspection ems- Signature (Owner/Agent), , . A Date �`j1• « w BUILDING PERMIT PERMIT# DATE ! VALUATION LOT 0WO-o`" TRACT ��e.aay���99 �7�♦��� ����ryry S28,0W.00 JOB SITE ADDRESS:%�^C�Tvi*D$i�l.©'AYE` APN OWNER CONTRACTOR/DESIGNER/EN INEER CHES :iER ROMPEU SIEVE, DODSW CONSTRUCTION DR,. 78-880 C ABRILLO WAY 73011 COUNTRY CUM DR., U111TE 1{4 LA Q1WrA CA 92253 PA1m DrisE&T CA 92260 (760)346-4032 Mif 1.044• USE OF PERMIT POOi, AND/OR SPA POOL, &SPA ONLY-ALARMS/BARRIP.RS S'tIAI J., BE IN NLAIC'E , T PRE PLASTER INSPECTION. POOL WUIPMis?I`I' EPICItOSURE IS NOT INCLUDED IN THIS MR.MIT POOL J N•D/O R SPA aa,000. oo t, x9rB.."TED CO Tr OF COPi ?`C!C"t`tE)N 28,000.00 PEW. IT FEE 1'Q:M11/.Et1:RY PIAN CHECK PEE 101.000.439.318 $176.43 CONSTRUC'TIONME 101-000-118-000 $271.50 MECHANICAL FES •- POOL 101-000.421-000 MAN ELWTRJCr`sL Floe - POOL 101-000-420-000 $0,00 P.LUM1311 0 IEEE -- POM. 101-000.419.000 $27.00 q SUB TOTAi, 001-4011 ITCTION AM.) MAN OMM $543,98 r:C= PRE 17E1s: $0.00 f. RECEIPT DATE til BY t r DJE FINAL INSPECTOR �4 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 OX 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 - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Neater 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 Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power - Final Utility Notice (Perm) COMMENTS: fL.r• ..: FIVE 12" CUSTOM CASCj -- EXIS REE GOLF COURS P/L 14' PAL/ 3?11 24 1'-6 of / 3 BENCH DEPTH U z BENCH DEPTH au'ane to curbs. sidpm,alks_drW�tays_ce-nen? ••1 R11 L GENERAL SPECIFICATIONS SIZE 15 X 28 AREA 327 PERIMETER 85 ' DEPTH 3X5 TILE CHOICE GROUPS SQ, 90 gg 18'@+12" ('nPIN(; CANTILEVER + MOTOR HP STA RITE Hp 1.5 MOTOR HP STA RITE HP 1.5 FILTER STA RITE 300 SQ FT FILTER RATE 102 GPM ❑ ❑ —=__EXISTING TREE_ .. -- -� ' ❑ ❑ ❑ SET FORMS FOR DECKING AT 3'X3' WITH 12" SPACING AS SHOWN EXISTING TREE 5 (, ❑ €'-` .211 El ❑ ❑ F I ❑ ❑ STUCCO BLOCK EQUIPMENT WALL 25' BY SDC EXISTING TREE IN y EQUIPMENT AREA TO BE REMOVED BY OWNER BOBCAT ACCESS R&R BLOCK WALL 8'-6" EXISTING TREE — ------------------ ----- EXISTING DECD 23'9" ■® EQUIPMENT �6 RESIDENCE NOTE: SEE PAGE 2 FOR WATERFEATURE + it PAL L fi �, 6AFETY [UEP1:PPROVED R CONSTRUCTION Imp 0� ` QY. Yr N 1/8"=1' SCALE NOTE: LANDSCAPE AND FURNITURE ARE SHOWN FOR ILLUSTRATION ONLY AND ARE NOT INCLUDED. rKIMMFR MnnFl AMERICAN If i TOW POOL GASLINE BY SDC FT. ALL LIGHTS 250 W CLOCK RS -4 ELECTRICAL BY. SDC FT, ALL A ' PLASTER DARK FRENCH GRAY DECK BY SDC SQ. 730 DECK TYPEACID ETCH / YOS BRWN STEP FT. SPA SPECS. DESIGN77 SIZE NONE RAISED NONE LITE WATTS RI LEVEL SEATS 22" 24" 27" DATE D 6-25-00 IS. DAMWAL " SPILL E REVISED -_44440 D Name: V CHESTER POMP�.El_l_) Address. 78-880 CABRILLO WAY Qlw LA QUINTA TRACT RANCHO LOT# . - rL"A:QUINTA PALM DESERT TEMECULA 73-011 COUNTRY 28910 RANCHO CLUB DR. STE F-4 CALIFORNIA RD. PALM DESERT CA. STE 206 92260 TEMECULA CA. 9 (760) 346-4032 (909)676 -SWIM GOLF CART EQUIPMENT WALL BY SDC BLOCK AND STUCCO MASTER BEDROOM WATERFEATURE SPECS AS FOLLOWS SET BASIN DEPTH AT - 18" FRONT BASIN FINISH AT +6" SIDE WALLS SET AT +36" BACK WALL SET AT +60" BLOCK CONSTRUCTION PERIMETER WITH GRAY PLASTER FINISH AND SMOOTH STONE PEBBLES 18" SHEER CASCADE 24" SHEER CASCADE 18" SHEER CASCADE HANDIG ACCESS PAGE 2 Name CHESTER POMPEII Address: 78-880 CABRILLO WAY Qfty. LA QUINTA TRACTRANCHO LOT# LA QUINTA