0207-006 (PLBG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under proviczions on,
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
Date 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:
(7� 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). / (/
O I am exempt under Section !B&P.C. for this,reason
Date :x Signature of Owner
WORKER'S COMPENSATION DECLARATION
j,.
I hereby affirm und& 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 Policy No.
(This section need not be completed if the, permit valuation is for $100.00 or less).
r�) 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 3of the Labor
,,,,Code, [.shall forthwith comply°with those provisions!'
Date: �' L Al 4 Applicant /-
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 lawsrelatingto the building
construction, and hereby�authoriie representatives of this City to enter upon
the above-mentioned.propert�or'in(spect n purpos s.
1' 1
Signature (Owner/Agent), '�'�'� -�` «;Date
BUILDING PERMIT PERMIT#
0201-006
DATE 0,'120CVALUATION 3sS 5�� LOT 105 TRACT 215953
JOB SITE
ADDRESS 7-9-149 (,AUXVROM20 APN
OWNER CONTRACTOR/DESIGNER/EN (NEER
79.349 PROSM-RO
LA QUINTA. CA 92253
CHUf
USE OF PERMIT
1.11M. WRIG
SEWNP, Z120TOR PUIdP PES..APpRLWED P1. NS.
V'ALUA TIOX
1120.0012
W-nMA'MD, 4 trf 0.1x` MWI"RM17OR
PFIRK0 :FRE SUMMARY
PLAN CHECK M 30),_000-439-338 $18.85
I"!. °s."('i : 4l :tP 101 -00(w.20 -0q0 $F$.' 1
JUL 0 2 2002
CFTYOFLAOBINTA
RECEIPT
I
a s13t3-I"O` ft�Lo l"eri%S` 1 'fti'C�i;iC>1•t'lal~113 7C�Z4AI`3 ri'.;fB1sC`l�.
TOTAL I' MWX T may DIM NOW
By ,- -- I DATE FINALED I INSPECTOR
$57..60-
$0,n0
,' .60
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 Firewalt,
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 .
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
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
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground CondLit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Powei
Final
Utility Notice (Perm)
>•�
I G� 0\NG & S ��
P ooNs�a
FpFt , I _ eY
MICHAEL SWARTZ
i Architect
PMB #14
A R£=INSPECTfON FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE, FOR A SCHEDULED
s , !NSPECThl ( �J 11'
3 IP EXCEPTION. t�
81-106 Highway 111, Suite 4H Phone 760-342-7867
Indio, CA. 92201 Fax 760-342-7867
Vie.l acs
�Ci0.�Pj p ye) t_ O It
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In
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�- JUN-�t�-G4'JI�G 1e � �.� L 1 titK. i r rui•a-�
I
..:r
]Uberty POLMUMPT,,
7)i7J 474 Ld3'J r. h1IW2
MODEM
LE41 M 115% 13a, Manual
LE41 A 115% 13W4 Avtoma4lc
Automatic models feature a mercury -tree wide-angle
float with series plug-ellowe for manual operation of
pump separate from switch.
FEA rURM.
• Meavy cast Iron construction
• oil filled, thermally protected motor
•
Pennanently -lubricated bearings
• Corrasion reshftnt, vortex We impeller made
of high temperature engineering polymer
• All stainless steel fasteners and rotor shaft
• Oulck-dieconnect power cord allows replace-
ment of cord In seconds without breaking
seals to motor
• 10' UL approved power cord - standard
(20' and 30' optional)
JUN -20-2002 10:34 LIBERTY PUMPS
LIE'OnoSERIES
TECHNICAL SPECIFlCAT/ONS
PUMP _
The pump(s) shall be model �9 ¢1A
as manufactured by Liberty Pumps, Bergen, NY,
or equal.
The pump(s) shall have a cap �
city of ,�PM
at a total dynamic head of feet. Motor size
shall be 4/10 horsepower, single phase, 60 hz.
and //'V volt operation.
MOTOR
The pump motor shall be of the submersible
type, oil filled, hermetically sealed and shall be
thermally protected. The overload element shall
automatically reset when motor cools.
Motor windings shall be of the class -E; insulation
rating. The rotor shaft shall be made of 416 stain-
less steel and shall be supported by lower bronze
and upper sleeve bearings.
The power cord shall be of the quick -disconnect
design allowing replacement of the cord without
creaking seals to the motor and/or oil chamber.
4J4 18Jy P.02/02
'
IMPELLER
The pump shall have a VORTEX style impeller
capable of passing a 2" spherical solid.
SEAL
The shaft seal shall be of the carbon/ceramic
unitized design, with. BUNG N elastomers and.
stainless housings.
EMRNAL CONSTRUCTION
The pump volute, legs and motor housing
shall be gray iron castings, class 25 or better.
All castings shall be enamel coated before
assembly. All fasteners shall be of 300 -series
stainless steel or brass.
LEVEL CONTROL
Automatic units shall be controlled by an
adjustable, mercury -free, wide angle float switch.
Float cord shall be equipped with a series plug
for manual bypass operation.
MODELS KP VOLTS PHASE AMPS DISCHARGE AWOMA77C IMPELLER
LE41 M 4/10. , 115 1 13 2" FNPT NO VORTEX
LE41A.2NP_ VORTEX
10' cord standard on above models. For 20' or 30' cord options, add a "-2" or "-3" suffix to model number. Example:
LF -41A-2 (20' cord)
DIMENSIONAL DATA:
Weight: LE41 M:_39 LBS.
Height: 13.5"
Major Width:10.75" (manual models)
Maximum fluid temperatim 140 degr o F.
��- .d•ie ."Certified
Jity of LA certification available
(SpeClfiCetIMS; 4ubjeet to dl 9e Mthout notIC¢)
PGAFORM M CE CURVE 1556 Dom
7U ZU 30 40 50 60rf 70 80
U.S. Gallons Per Minute
0 1.4 2.8 4.2 5.6
liters Per Co- -
on
Lfbertty Pumps a 7307 Lake Rd - Berges, Neta York 14476 • Phone 1(600) 543-2550 Fax (716) 494.7839
Wbb Sete: ht p;//wwwfibertypumps.00m 7292 RS/98
TOTAL P.02
■
7U ZU 30 40 50 60rf 70 80
U.S. Gallons Per Minute
0 1.4 2.8 4.2 5.6
liters Per Co- -
on
Lfbertty Pumps a 7307 Lake Rd - Berges, Neta York 14476 • Phone 1(600) 543-2550 Fax (716) 494.7839
Wbb Sete: ht p;//wwwfibertypumps.00m 7292 RS/98
TOTAL P.02
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by lawto put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer,and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under. Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing 'their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
LaQuinta,. 3
(760) 77012
FAX ;A0;777 -7
OWNEWFPIGNAT�M/LATE v
71- do N� U
PROPERTY ADDRESS
G) 2` o7 _ 924
PERMIT NUMBER(s)