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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. E l� ADDRESS INSPECTOR REMARKS: � �)--A, t 4-v 0 X) v Cl I La rf ti Ct.�t rC, C1, .I d J (`.4 (i r <' J Ul V. DEH -SAN -118 (Rev 2196) Distribution: WHITE—Office;,CANARY—Owner; PINK—Office 1� -b� C� c ; 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: