0207-133 (RPL)LICENSED CONTRACTOR DECLARATION
!'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 ''g^: .
Professionals Code, and my License is in full force and: effect.
License # . Lic. Class Exp. Date
' r'
/Date �f �� �' 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.
"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 SStr „�, Policy No. 1640=134-01
(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 ithe workers' compensation provisions of Section 3700 of the Labor
Code I 211forthwith comply with'those,provis1 ps.
Date: `�-� �% Applicant-~'"""
r
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety.
for a permit subject to the conditions and restrictions set forth,on his
application. d,
1. Each person upon whose behalf this application is made & each person at' ,
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&• hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify1hat I have read this application and state that the above information is
Correct. I agree to comply with all City,. and State laws relating to the building
construction, and hereby.authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Ageht) Date,,,
p -
~_` "' BUILDING PERMIT PERMIT I/
VALUATION
DATE 07M/20 v1 aL7'1D • LOT TRACT
JOB SITE S 4 9-M1 RAl�'C.'W..0 �,• 'A1 C.°I D
ADDRESS
APN
OWNER .
CONTRACTOR / DESIGNER / ENGINEER
Ia_
lyff�.�%�iey :r��?vAox, enarr�.�R{�•r��°$r�:o�•r�
((� D �ejf����{c+wWUS.[�M`��T��� y�,•
49-6130 A.�.0 i� ]A0 T1 L' . � Tb' f A.D .- �
4.1 '-995 11-10A,�..Sr�W.S!�. K �7 �.[ IE' �k y .
Fri QUANTA Cl -k 92233
PALi41: DEt91?-%'T M 922601
6560
USE OF PERMIT
4J,01a.:g4D101a SPA
:POOL AND SP-AON'LY'.RTtQ ,lSAIMIM SHAIL BE IN, Pf.ACT PRIOR
!' ISPEC:TION. POOL EQUIPIM s, T EXC`.i.OSURE NOT
3'oi:33: AN.E7.1O:'3 SPA. 30000100 .La
.[S!AJLMATSD CO0.7-f. OT's CONS3,A9.0.i�.rh.i[.O.N'
.3 WGD.EiW
PLAN CHECK FEE 301-000-439-318 $184.93
CD:NS`t'i2IX TION FEX 101 _00"'I 9-000 $AK$9
$9
11KE CKANICAL F .-- Pool, 101-000421-000 $24.00
1rL,FC.1'P r_A1,F X --POOL 101-000-420-000
PLUMBING Elle - x+0011 161-000-4159-000
12v,1ECK
Stffi i'�5'���� OX!RI.�r.L'i�`".1;.C�J�' J�.�%T°1 I�1 - NCIO
$56,,5.$ 4
$56
LEM FER0
fl
$0100
CITY ®f +QUINTA
FINANCE®E
REJPEIPT
DATE
".i
BY
DaE FINALJqD
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel _A v L=
Set Backs
Electric Bond
rootings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
_
Encapsulation � l��
Gas Test
Appliances
Final S
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)
COMMENTS: ��;� � :fid s
4ORM Mal C MVWGEM0
- .
T 0JL
SPECIFICATIONS
POOL EQUIPMENT 41-99.5 Boardwalk Palm Desert 60-568-9200 SPECIE
- Pool Size ... 22' x 38'
O
Spa Size.. 7TREEFORM .
Pool Area ... 545 sq.ft.
Spa Area.... 50sq.ft.
Pool perimeter .... 96ft.
a -
A,. Spa Perimeter .... 26.ft.
Boulder Spillway +18'Quartzite Outside Surface;
Pool Depth .... 4'0- X 8-0"
P/L Spa Eleva...+18"
Spa Jets...6UPPER 2 LOWER
Lights..1 /400 1/100
' TO Autofill ... M.P.Products
- Depth ;
EQUIPMENT
. 22,0 . _• I . ..
38 0 Jet Pump.Wisperflo 2HP.
i'8.0" 'SKIMMER, Cir. Pump Wisperflo 1 HP
i -
.Depth
50
TANtQN6 LED6E Filter .. .
UMBRELLA SLEEVE .
Heater Pentair ' MinPentair iMaxlar 3 400
Fire Pit 18"h x 60" x 42" h
Timer ... Jandy Aquaswitc
- Cleaner... Paramount PCC2000
p/a _ _ :Aquarite Saline System
DECKING - Decking color... COLOR TBS
---------- -------------------- Square feet ... 1700 +/-
Dynas D8Q 30 Bcr-B-QUe
Tile Choice ... GROUP 3 T.B.S.
A RE -INSPECTION 'FEE OF $301Pebble ..Superior Az. bold
s4 WILL BE CHARGED IF THE APPROVEDJL
i I - 71- PLANS ANUTOB CAROL ARE NOT ON
- - r FOR, Mr -THE ITf A SCHEDULED Mrs. Muse
INSP`i� l i,..�F QI.��NT�1 - _ Lot #53 Talente
EVIN
_ _
. 6 e
BUILDING &.SAFETY DEPT.:
EPTION � �� 49 80 Rancho La Merced
�:.
_ f APPROVED' t ..
ACCESS
Uinta
i FOR CONSTRUCTION SCALE: 1/e" = 11-0"
• .;i _,. _: � _ _ - , � � . _ _ ' _ ''`. _..- .MARCH 22, 2002
Da 7-a3-&' By .
® . 1
1 Plan Approval By Date