9908-165 (RPL)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
174127 A. 0.813M91.
Date 79ignature 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 T± 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 rryn 'q Policy No.
(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 tworkers' compensation provisions of Section 3700 of the Labor
Code, �Zifoth complyrwith those -pr • v ions.Date: -th plipIII it th6s p gi
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. 41
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void. if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for -in ection purposes.
ee
Signature (Owner gent)"" � ��� Date
BUILDING PERMIT PERMIT
DATE ��"VALUATION •s�:f�. LOT TRACT
S 45-040 l�h'A.,M.�ir)�eR::V�Ix9.SCN.0COURT JOB SITE
ADDRESS
APN
`
OWNER
CONTRACTOR/DESIGNER/ENGINEER
45-040 RJ%AtRLFW000 CCXWf
730 11 COUNM*YCLUB DR., SUITE F4
LA QUIVIA CA.
PALM MISIERT CA 92260
(760).?404037 C PI* .,4; 1W,
USE OF PERMIT
P0(_tl..N� .4!491., S1"A
POOL & SPA G1tiiA' - NLAIZA1IVERA.$Z.ELERS 8Hr1L.?t E 1N k'i.A �s Xf
PRE -PLASTER 1NSi?K,'UK)N
P7+:i.L ANDAR SPA 16.W.00 LS
.LQ 4a:��44:rdI CONT 4.i'&y �.i3OIA.®o�S/B D.b:416.Anl'V
4�t�9i+.193!
PERMIT FEE MAJAINdNIR
PLAN CHFAX k1M 101 -0(* -439-348 11.17AXt
ra,'C` AINIC'A,L T, U, -- POOL.1.itt�llUe:f-,.gel 0(}C! 4�..if�
IIlL' kIC. A FjEE -- Po of
PL1JS%33 TN0 FE17. _. Pc. )A fOl fa i•• D9-t)dit) 52701
`"F '11-TOTAL.C`.t"1'1d1S'('ttf.fC"Crf �' ! AND PLA CHPA' " .
`F;391 N)
'SS PRE -PAID FEES
Tf3'1'r\L ,g'E?la,'�1I.T FL+:W% O9;l C NOW
SS -93.00
4
r'
RECEIPT
DATE
BY'DATE
FINA LED
INSPECTOR
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
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric_�y
Underground Plbg. Test
!�+
_
Final
PLUMBING APPROVALS
Gas Piping±`_
Gas Test
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
4v✓
7
%—/c�!
Appliances
Final
(T.• Z ��ai�i
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)
UACKEQ WATERFALL
W /ROCKY MOUNTAIN "RTZ
WATERLIN A CAP FOR CASCAU.
�\
RETURN LINES 2 "
SKIM ER MODEL C "
CHECK vALvE YES '
♦ISTOP OF DAM
POOL LIGHT 4.00 W CLOCK
WALL
AUT,Om@9D**f 6
CHEM?.e**m.m��
PLASTER COLOR WHITE
DECK BY SDC SQA 63
DECK TYPE SLT FNSH NTRL GRY
WATERLINE
1i s
4&'
LITE 100 WATTS
BB
:.t
D'AMWALL TO "
SPILLWAY SIZE 3" X 12" WIDE
CDII I WAV' XXODGn11 : ri'hlzrn
t. va
18 WIDE
:S PA DAM
A«
WALL
SIT & SPIN SPA VERTICAL
FINISH DECK---�
DECK
VENEER
REVISION A
( ADD PATIO COVER
& DECK) j
CRESTA GOLD BOULDERS
NOT TO EXCEED 24"
AIRPIPE
s— R6'-6"
Ida' -6"
PAT10 COVER BY -SDC
RESIDENCE
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB
FARD ARE NOT ON
A SCHEDULED
THE SITE OR
INSPECTION.
.NO EXCEPTIONS!
0
AQUASWITCH
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE BY
G/E
19'-6"
T
k,
i
R6'-6"
4,
P/L
s
CONTRACTOR cannot assume res on i ili y for GENERAL SPECIFICATIONS
da `tee to curbs, sidewalks. driveways, cement SIZE 14 X 28
slab., sewers, lawns,tree_s:, fences, reta.ining
walls- sprinklers, telephone tines or shrubs. AREA 331 PERIMETER 76
Wh.en access is made through a neighbor's DEPTH 3X
property it is understood that you, the owner. TILE CHOICE GROUP 3
have that neighbor's permission and assume full RBB. 9'@+18"
COPING CANTILEVER
IT
signature POOL A 9,600L
PUMP CAPACITY 103 GPM
MOTOR HP TRrTE HE 1.
MOTO�Nrm m m m = m�FIP
FILTER STA RITE 300 SQ FT
FII TFR RATF .102 GPM
DESIGNER
RANDY 7 •
DATE
776-99
't FvrcPrn f
SUCTION LINES 2 to
RETURN LINES 2 "
SKIM ER MODEL C "
CHECK vALvE YES '
GASLINE BY SDC FT. 125
POOL LIGHT 4.00 W CLOCK
ELECTRICAL BY: SDC
AUT,Om@9D**f 6
CHEM?.e**m.m��
PLASTER COLOR WHITE
DECK BY SDC SQA 63
DECK TYPE SLT FNSH NTRL GRY
STEP FT.
SPA SPECS.
SIZE 7 RAISED YES +18"
LITE 100 WATTS
RI LEVEL SEATS 22" 24" 27"
DAMWALL STACKED
D'AMWALL TO "
SPILLWAY SIZE 3" X 12" WIDE
CDII I WAV' XXODGn11 : ri'hlzrn
#JETS UPER LOW
NaffigL MICHAEL ALCIERI r.
Address: 45-040 RAMBLE WOOD CT
QAL LA QUINTA
}� Tem
® s®'I
DBCAT ACCESS
tR BLOCk WALLGATE P&v/s
T PALM DESERT TEMECULA
N 73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIfA RD.
1/8 =I SCALE PALM DESERT CA. STE 206
OTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA.
ARESHOWN FOR ILLUSTRATVON (760) 346-4032 92590
ONLY AND ARE NOT INCLUDED:L�)676-svwlM
1 Ir Ate_r,7eI '?7