0207-226 (RPL)LICENSED CONTRACTOR.DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C;r,. pter 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
5. 2660 ce ._ 413W03
Signature of Contractb7'"'"-'""'�'- _
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.
(. ,Q.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:.
Cartier ,USSR Policy No.IM0484 ill
(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,,•shall forthwith comply, with those proylsions.
Date: % 12 Applicant
ir,e.1
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.
11
I certify that I have read this application and state that the above information is
correct. I agree to comply with alIX"ify, and State laws relating to the building
construction, andhereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. `
Signature (Owner/Agent) 1 r'� Date
BUILDING PERMIT PERMIT#
020,7426
DATE VALUATION a8twom LOT TRACT
's. 57,v2>
JOB SITE
ADDRESS 79-,67..' IRCEE0 �O)CA TiUt P.C;.F7dil�.kt�
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
140sER:SYLK
MmUr P,00LC,ONSaRXCTION
7f -!V 5RCtiCHO SAWpmGAM�y�
41-99BOliSCtIZZE.A 1 .
1A QDI-14TA CA 92253
PIWM DRARM CA 92.260
(76-0)5&8-9200 CUL4 060
USE OF PERMIT
POOL AXWOR, 81,Vk
f'C3OUSPA. d,LAi'.108AUIERS:iHALL BE IN PI.PClA PR.F+rPLAS'i'FA
HIPEMION. RQUIPME-41T EKWSURE NOT MCL i DED
i
POOL-A-SIXaR, SPA 20,0n.00 AAS
WW10 COU OF CONSTR 7'CITE' N
-yy�• g�q5� g �yy, y, }� ��'+q yk.g�y"3.T
la .�LXY+i.V.f��A,:B3 SiP.[L1�1.1Mtl,d.C.L 16
MAN e-HECIC RE v
CaI&TR11CT1OW FEE 103-obo-X118-000 $z/1.50
MECHANICAL ME— POC)L 101-000-431-000$4.00
LSEClridCma YEZ u- POOL, 101 —000420-000
�t
4
PLAN Mil
Alli; 0 5 1001
CITY OF
FlNANCEDEPT,
RECEIPT
DATE
by
D NALED
INSPECTOR
r� _
a3
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
POOLS - SPAS
steel/ 2—
BLOCKWALL APPROVALS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric U" lK�=
�—
Underground Plbg. Test
Final
Gas Piping
�C
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
�i--
Plumbing Final 1� -
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)
MERRITT POOL CONSTRUCTION . Inc .
41-995 Boardwalk Palm Desert 760-568-9200 Calif. Lic. # 542660
PA
DEMNS
.T
4
bECKING
11yo
DEaXNW
CI
TY
OF
F
LA
QU
INzT,1..,A
Sylk Reside BUILDING &SAFM DEPT,
APPROVE[
FORLNTRUC71
DA S -
,
SPECIFICATIONS
Pool Si2e.....18'X40'
spa Size ..... 5' X I V
�iPool Areo..._580;w.ft.
—Spa Area. ..45—sq. ft..
Pool perimeter ... 104_ft.
Spa Perimeter .... 2e—ft.
Piol Depth 4'_)Lg'—
Spa Eleva ... I +j 82
Spa Jets.... -6— UPPER 2�_ LOWER
Lights. -2/400 1/100
Autofill ... M.P.Products
EQUIPMENT
Pump -Pentair WT... 1.5 H.P.
Ptrnp.Perrtair W.F. I H.P.
Filter—Pentair CC420
Heater Teledyne Lears.EPL400
Timer—Aquaswitch
Decking color... TBS
Square fee... —2200_
Tile Choice—GROUP 3 T.R.S.
Pebble -TBS---
Mr. Robert
Sylk
79676 Rancho Santa MdNorha
La Quirda