0206-086 (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{
77?.601 C.13 WC iry��-- _ �N.�;iQrf.�.�
Date r�''�-� Signature of Contractor-'' Z_- � _ -c --r _••-=
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.
(.Y . 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 STATE F'U14D Policy No. 22-042POID
(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 workbrs' compensation provisions of. Section 3.7.00 of the Labor
Code, I shallJorthwi' h comply with those proVigions-
Date: !,-ti //11 ,:Applicant y'' "i/ '!iaa. - tt!✓.�'^ y_ �� .. _ .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application.is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize repose atives .-this City to enter upon
the above-mentioned property for inspection purposes..
Signature (Owner/Agent) i� :w�y�- ,Dated
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
! G.
'JOB SITE
ADDRESS `�+ -406 CAYJ,,E PROSiI$,�;. O
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
. OF- & Mmty S A--)
CAL-1,TXVAiDA Pt7r 12, .*NC.
79-406 CALLEFROSM-0
7 0-180 THUNDER ROAD 43
U, Qi.!`IMA Ct1, 922 5 3
RA%3C140 NI MACME. ^A. 4}2271)
(76G)S31-0860 MIR 31135
USE OF PERMIT
POt: L AND SPA C?NLY. i t L,? C)F$' BWC K WALL tN Y y'Y.Daldi5AR D.
ALARMSMARRIMS SIM11 BE Ila PLACE PRIOR TO Pii1MAURTER.
$,, S)'XCT1ON. POOL IsQUIP- SENT iL'NCLOSiME'NOT lr1s:.°?.UDEE) M PFitMIt..
POOla ANTWOR SPA, 14
5 F7, WALL 117.010 t Y
PIAN alECK X14 10
C014S RUCTION MeM 101-000-418-000 *.234.ac,
i!lilr,CKMICAL nE �= POOL 101-000421-000 $24.0
EL.ViCTIUCAL ME - POOL. 101 _000-�.' 20no 10 $43100
i'i::dM110%10 Fero . POOL 101-000- 419-000 S27.30
S'(;UV1"O°I•AL C ONMI R'C'''E 01.1 AMD PLAN t,MCK
ww82.10
1-103 RUR-PADMM
S0100
JUN 14 2901
WY®FLAQUINTA
FINANCEDEP'T.
IECEIPT
DATE
Bx
DATE FINALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
E BUILDING APPROVALS
MECHANICAL APPROVALS
-
Set Backs ! {
Underground Ducts
Forms & Footings 1+.
Ducts
Slab Grade i I
Return Air
Steel I I
Combustion Air
Roof Deck ; s
Exhaust Fans
O.K. to Wrap !;
F.A.U.
Framing #
Compressor
Insulation i 1
Vents
Fireplace P.L. I I
Grills
Fireplace T.O. i I
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall 1
Exterior Lath I 1
Drywall - Int. Lath i 1
I{
l;
Final
-
Final I
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs I S
Electric Bond
-
Footings —
Main Drain
r O 2
Bond Beam i I
Approval to Cover
1 #
Equipment Location
Underground Electric
-
;1
Underground Plbg. Test
-
Final 1 a.
Gas Piping
- 5X -p
PLUMBING APPROVALS
i
Gas Testpj_
Electric Final
Waste Lines I i
Heater Final
Water Piping S
Plumbing Final
Plumbing Top Out'
Equipment Enclosure
+
Shower Pans I #
O.K. for Finish Plaster
Sewer Lateral #
Pool Cover
Sewer Connection {
Encapsulation
_
Gas Piping
Gas Test t
Appliances
1
Final.
-
Ir
!1
{#
Final jl
Utility Notice (Gas)'
,f ECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit
Rough Wiring I.
Low Voltage Wiring
Fixtures # i
Main Service
Sub Panels i i
Exterior Receptacles
G.F.I.
Smoke Detectors i i
Temp. Use of Power
IE
s1
Final
Utility Notice (Perm)
COMMENTS:
CAL -NEVADA
POOLS
MARK TOW
70180 THUNDER ROAD
RANCHO MIRAGE, CA. 92270
PH 831 0860
LIC, N 777601
4At k ��
Ri x � .;•�
/-k v6
L
i F ,�55
otr{ d
43
�cP`h �j�ur►
j
171 i, O
c,Rl.lC- bv�Z
1 � J
P4
Designed by
KERRY R. KOEHNLEIN
PHONE -360-0012
CZ! --
P L I,
Z!
VICINITY MAP
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
POOL SIZE —N x2�'l _Depth -.Z-- x-1 X (..
Surface Area s3(.
`C,
11
Grading I
I
Obstacles ^�
Walls Removed Js -4
Replaced S
Misc.
Misc.—Glass—Etc.
PLUMBING Filter -,To, e- C.. a* --r
Size
Pump-Tk c Size 111-7
Booster Pump 7e'%1
Skim Run Main Drain
Designed by
KERRY R. KOEHNLEIN
PHONE -360-0012
CZ! --
P L I,
Z!
VICINITY MAP
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
POOL SIZE —N x2�'l _Depth -.Z-- x-1 X (..
Surface Area s3(.
Perimeter 7 (o
EXCAVATION Access P-
Grading I
Dig From S h �k "co cu
Obstacles ^�
Walls Removed Js -4
Replaced S
Misc.
Misc.—Glass—Etc.
PLUMBING Filter -,To, e- C.. a* --r
Size
Pump-Tk c Size 111-7
Booster Pump 7e'%1
Skim Run Main Drain
Ret
FII Line A- J'1 J Purifier ✓ T o ra L L --11"
Auto Cleaner
Htr Type 5 T.,. ei r Size -!A -L7 o DDJ
Gas L*--! O
FOUNTAINS—SPRAY HOS—WATER EFFECTS
Type 5h eco- 1) e$Ce--r
Sae 3
Plumbing Length r7
Valves i A uT
Booster Yes6Y Type
Size
Misc.W toe V- S D i� r G14, C-, p'�
STEEL GUNITE Eng
Sur -charge
6• RBB 12• 18•
`' u 24•—
Step Risers`
Spa Wall Width
Benches
Love Seats ti
Spa Dam Wall 1; �
Notch L4' I -L �i•
ELECTRIC Total Run L/F---�
Fiber -Optic PO
Remote s- L
Spa LI G n r �n
Misc.
TILE W/Line* u P. S
Coping-!�7A�J�
Step 8 Bench Tile! e. S
Misc.—Glass—Etc.
DECKING Sq Ft -y 5 0 Type 5Q �-- _ Color_
Nat Concrete Sq FtCantilever�p
Com_
D.O.D.L/F • Step Risers 3
Misch
5PA Size I T '6 Area J v Per_, Y
Pump Blower_�L-" Spillway-}"
Jets LP Step "2- light l o J
Misc. I 5o0,f l (,ovJ -;lM tri -L �'ET.5
INTERIOR FINISH �2 IN Ca r%11. L)1! Ior 14
Other
t OWNER to fence pool area and install self closing and self latching gates per code.
tLLNOTE: No dirt will be removed, returned or graded after day of excavation. OWNER u e- qijyNOTE: Relocation of equipment pad will result in additional cost to owner.
NOTE: FII pool immediately after plaster (follow instructions). Do not use rubber hose. ADDRESS 1 S L{a { ra Li? OL
NOTE: Do not turn on pool light when pool is empty.
i NOTE: Wet down concrete shell at least twice daily for seven days after shell is installed. CITY SOLD BYILN DATE ^S �'�
rI have reviewed this plan and hereby approve total plan & specifications. PHONE (H) 0 0 S H 0 (W) f�- .-�y4 l
DRAWN BY Z DATE4—
DATE CUSTOMER SIGNATURE
I '