0203-120 (RPL)LICENSED CONTRACTOR DECLARATION
,itiiereby 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 P. Date'
54,2660
Date'^%pt'r+�t Signatureof,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 & Professional's
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 workerscompensation 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'
Mae, 1�PT y lf�Zt�46kf...EZ�
(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 prop ovisions of Section 3700 of the Labor
Code,1'shall forthwith comply`With ' ose' Isions.
Date:ALL 9 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 laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for i specilon purposes.
Signature (Owner/Agentf Date
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BUILDING PERMIT } PERMIT# '
/ .- ,
DATE .; VALUATION LOT•' `" �r'�� TFAG`„a•
JOB SITE
APN
ADDRESS 7 2 T.0 ;P) % Ri w'e`ar
PM
OWNER
CONTRACTOR/DESIGNER./ENGINEER
'F �LV S.r.L'� $i�J.l,p®e..ZZi.�ALL
AVa.b"S�`N•�+.A. .f.`S.Y�1J S:.u,{LZP /i S..i'SLi�,•J 2,AVa'9
79,429 PASSO DEL REY
43 4Z BOATva'�WIJK:fJ EZ A -I
LA.Q iNTA ('34 X253
1),P.1'.,Iv Dym; rr CA 92260
"t�s�)13 � f9t3 CrBldf, 6560
USE OF PERMIT
P001, AND/4C)R M>.k
P00.US�A.Ai;,Al2':PeF.;lSA1P.K6MS s13,tt LI, HE 1T: ,PL ACIP, AT VsMPI. A.S'd`ER
WE NASSIR&W PER 39 " UA. C §304.$
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
l
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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
_ Z
Footings
Bond Beam
Main Drain
Approval to Cover`4
Equipment Location
r
Underground Electric
Underground Plbg. Test
Finat
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-7�
Gas Piping
Gas Test
Appliances
Final
r
rival
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Wain Service
Sub Panels
Exterior Receptacles
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
CITY OF LA QUINTA `
BUILDING S SAFETY DEPT.'
..APPROVED
FOR CONSTRUCTION
m� �► � .�...� CONSTRUCTION
a
RITT. POOL CONS
N
'. o
o
SPECIFICATIONS
Pool Size.. .22' x 38'
Spa Size..7'FREEFORM
Pool Area...545 sq.ft.
Spa Area.... 50sq.ft.
Pool perimeter .... B6ft.
spa Perimeter- .. 26. ft.
Pool Depth .316" X 6'O"
Spa Eleva.._+18" -
Spa jets .... 8 UPPER 2 LOWER
Ughts..1 /400 1/100
Autofill... M.P. Products
EQUIPMENT
jet Pump.Wisperflo 2HP.
Cir. Pump Wisperflo 1. HP
FiIter ... Pentair, Maular 350
Heater Pentair "MiniMox" 400
Timer...Jondy Aquoswitch
Cleaner—Paramount PCC2000
Aquarite saline System
Decking color... 600y
square feet ... 2500 +/-
Tile Choice...6ROUP 3 T.B.S.
Pebble - Color TBS
Mr. & Mrs.Vance
Boucher,
79-429 Paseo Del Rey
La Quints
..v. -U 118' • 1'-D" .
SolNo .�cexI
'
SPECIFICATIONS
Pool Size.. .22' x 38'
Spa Size..7'FREEFORM
Pool Area...545 sq.ft.
Spa Area.... 50sq.ft.
Pool perimeter .... B6ft.
spa Perimeter- .. 26. ft.
Pool Depth .316" X 6'O"
Spa Eleva.._+18" -
Spa jets .... 8 UPPER 2 LOWER
Ughts..1 /400 1/100
Autofill... M.P. Products
EQUIPMENT
jet Pump.Wisperflo 2HP.
Cir. Pump Wisperflo 1. HP
FiIter ... Pentair, Maular 350
Heater Pentair "MiniMox" 400
Timer...Jondy Aquoswitch
Cleaner—Paramount PCC2000
Aquarite saline System
Decking color... 600y
square feet ... 2500 +/-
Tile Choice...6ROUP 3 T.B.S.
Pebble - Color TBS
Mr. & Mrs.Vance
Boucher,
79-429 Paseo Del Rey
La Quints
..v. -U 118' • 1'-D" .
SolNo .�cexI