0012-248 (SOTB)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 # Lic. Class Exp. Date
1 188/� 13 ? j I Oil 2 R2(
Date 'W ` 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.
(�, ,fhave 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. `
0301, DF11l R.11.6t; TH00.' KINC $44068-01
(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 those provisions;•,
Date: /i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
j> $ l
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing_
_
a
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_c� _
BLOCKWALL APPROVALS
Final
POOLS - SPAS .
Steel
Set Backs
Electric Bond
Footings
Bond Beam
�� /,�
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
3k
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)
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
79-405 CANTERBURY COURT
Use Classification: COMMERCIAL RESTROOM FACILITY
Occupancy Group: B Type of Construction: VN
Bldg. Permit No.: 0012-248
Land Use Zone: CR
Owner of Building: CENTURY CROWELL COMM Address: 1535 S. D STREET STE 200
Building Official
City: SAN BERNARDINO, CA., 92408
By: BILL GORDON
Date: 1/28/02
POST IN A CONSPICUOUS PLACE
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
,,. DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEMENTAL REPORT TO SAN. FORM # DATE
SUBJECT 1 . �-�'^� 1.�,�,.,�, _ E'��c, { 1 r PERMIT NO.
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ADDRESS
INSPECTOR
REMARKS:
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DEH -SAN -118 (Rev 2196)
Distribution: WHITE—Office;,CANARY—Owner; PINK—Office
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City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form: to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Common area pool @ 79-405 Canterbury
Century/Crowell @ The Tournament Collection PGA West
Applicant Contact: Marty Bulter 909 3816007
Application / Circulation Date: 11 0
PP 06 ��
Date
Community Development Department
�r
Christine di,lorio, Planning Manager
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Greg Butler, Building and Safety Department Manager
RETURN TO NICKIE GORMLEY ASAP -
1--L I !'t
Date
Date
Date
�/0 10
��I l
.City of La. Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Common area pool @ 79-405 Canterbury
+ -Vol Century/Crowell @ The Tournament Collection PGA West
Applicant Contact: Marty Bulter 909 3816007
Application / Circulation Date: 11/06/00 p1
Date
Community Development Department
Christine. di Iorio, Planning Manager
5.
Public Works Department
Building and Safety Department
Greg Butler, Building and Safety Department Manager
RETURN TO NICKIE GORMLEY ASAP -
f--.
Date
/l Z7 Zm-D
D to .
irate
County of Riverside - Health Services Agency
Department of Environmental Health.
Public Pool Specification Sheet
Owners Name/Address (DBA)
City Ssi�c.uJsscn:,lo
Contractor'sANa�m�e/Adddrress
City 2 V� 1 /L�J�IC Phone NTo.��Lj �L\�
PoolLo ac ior/Address 77-,/o!5 G►,r6.cbj;y
;fes"
i; A
Far No.—, -rte 3A LL
City &I. -MA ,
plot Plan - Shows all existing and proposed'faciliiies including pool enclosure
Scale (1/4" = 1 ft) - Plan and profile drawings _Mechanical equipment and plumbing lay -out on -plan
Approved restrooms, showers and drinking fountain if any dwelling units over 300 ft from pool
Pool Capacity _�Al_qvje�Gallons Surface area 798 sq. ft.
No. of skimmers MatCe�gModel S -moo Proper Equalizers_ Anti -entrapment cover
Number of return lines v Type of pipe: PVC Scn 40 Copper Pipe size at head Zt 2
Pump: Make Modelz�P3c/5 EF�7 .Hp Gpm @ 60 ft TDH
Filter Type and Size- D.E. @ 2 gal/min/sq.ft.1-z_�
Sand @ High rate - 15 gal/min/sq.ft. _ Make o a ems_
@ Rapid rate - 3 gal/min/sq. ft. - Model
Separation Tank- Make Model Dry well size G ft x j z ft Diam S ft
Backwash via:legal air gap Site glass - Sewer — Dry well X
Pool Construction: • Gunitz_ Other — Color: White__
Chlorinator: Make �J�f Kn fel Model c0
Flow Meter: I%W-e1��_o e7lkly/TCModel " 4G q o Influent and effluent pressure gauges
Hand hold $round entire perimeter: Bullnose — Other Z�L All corners coved 7�
Split main drains A-riti-entrapment covers X All safey signs X- Body hook & pole � X
Life ring 8 rope Proper steps- Proper ladder,; recessed steps, grab rails_ Proper hand
rails Depth marker (side, end, deck)4" wide line across bo-LLom at 4 1/2 ft. depth
Deck 8rainage 4- Unobstructed non -slip walk -ways 4 ft wide around the entire pool perimeter_
All pools at 1 -east 6 f apart_ `Fater supply and fill line from approved source and approved back floe
preventer�,�4_ Approved test kiUnder.;__ li�it�_ All valves and controls identified_`
A 5 ft high fence around pool with self-closing, sen= latching nates, gates must open outti ards� Openings
-
in fence must not exceed 4" -wide and 2" at bot -Loo r y y �
•dditional requirements:
County of Riverside - Health Senices Agency
Department of Environmental Health
Public Spa Specification -Sheet
Hers Name/Address (DBA)
:5;,J—6,r JAc n,. o .
:tractor's Nane/Address (�
A 1,tv� 17 5�(L
A Lccation/Ad'dress 79- 46S 6Q,j;-&4au•zY . City
f, j-ro4,1 �c a✓ tu- CoAw .,,; J rr/ E 5
Plot Plan - Shows all e:cisting and proposed facilities including spa enclosure
Scale (1/2" = 1 f) - Plan and pro,9-1e drawings �—Nfechanical equipment and plumbing lay -out on plan
.Approved restcooms, showers and drip -ung fountain ifamy dwelling units over 300 f tom spa
Capacity 2l SS _ Gallons Surface area�g sq. ft.
o`skiruners_ Ma':eMQ�iodel 5 -�� Proper Equalizers�Anti-entrapment cover
-1ber of return Enes_"iL Type of pipe: PVC Sch 40 Copper — Pipe size 2t head__
:1p: Make PA `� y(10D Model 2&2%)(25 Hp_ J -v Gpm @ 60 f TDH ��
_2r Type and Size: D.E. @ 2 gal/r-in/sq.f. /ZG
Sand @ High rate - 15 gz/mirJsq.f. — 3v1a_ke ��� i Yi% p
@ Rapid rate - 3 galrunrsq. f. Model R 6020 .
aration Tar -k-: Make Mode' Dry well size (;-f x�f Dia,
S f
.v; ash �za legal lir gap -� Site glass — Sewer— Dry well )—
Construction: Gurute �- Other Color:
o ina;tor: Mae � � � , t n �, r ,� Model o c ;
Miter: Make LLC / ,T -Model 2 Influen. and eluent pressure gauges
d hold around entire eri.meter: Bullnose Other Z v`� A11 corners coved
main drGl,s Arti-entrapment corers x. AI Spa safety signs_ Body hoof: & pole _
ri:�g L rope _ Proper steps_ _ Proper ladders, recessed steps, grab rails_ Proper hzzd
Depth m rkers_� Dec,: drainage_ Unobstructed non -slip wal_�-way'S 4 f titizde arourd 50%
?a 'perimeter All pools at least 6 f apart ��''ater supply and fill line from approvzd source and
-owed bac'; flo:v preventer_� Approved test kit_ Underwater light_ AL valves and controls
._Sed A 5 f hicn fence around spa with self-closing, self-latchir` ales, gates must oper,
;a=ds Oper'u gs 1:1 fe,-ce rn-_5" no: e::ceed 4" vide arid 2" at bottorni 24-- Contrasting the for Step
ber:ch_ Spa e-MergenC s1lutoMs "I,C� -
tiO.ri requ�reme:lts: