0010-074 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
t♦haptF'r 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
5`7412'7' A 0101/2C
:Date'+1�`,� Gt (at 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
r
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.
( )f-1 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.
STAT r arty f�4i-0ti 0i?OfS� 4
(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 provisions of Section 3700 of the Labor
Code, I shall fort with comply with:tt%ie provisionso "
17ate: % Applicant'"
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines Lip 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 inspection purposes.
/Signature (Owner/Agent)" = Date 'f G7
V
BUILDING-PERMIT PERMIT#
DATE n VALUATION LOT OD;]." 14 TRACT
JOB SITE
APN
ADDRESS
4.3 -WO MIMES COTM.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
A IMIM2141AN
SrMNE DODSON CON M., LYG'°TiON WC.
7301�O"f 'I'E �! G`L�L # DR J1�5��"4
CA 92260
(760)346.4032 CBT. 104,4
USE OF PERMIT
;BOO &SPA ONLeY-a4,IARIVIdrMdt"r+'.Itl�'> S Sl'WL BE 121 PLACEAT PRE..
:13d `t.HTS'�NRk�1T a
KOleANDMRSMA 01000.00 L3
r
391MAMD COSIT OF OCallhIM i iON
111M CHECK-, F11Y,
Mrrt�t€,>�NICAF, FEE— P00E, 101-000421.000 524.00
i:iZC`3 RIC,.A.L MZPOOL, 101-000-•420-000 $43.00
m'Umom Fu POOL 101 -0=419-000 S27A
A
'
MIS -TOTAL C0X3TRLT=0 .AWT) PLAN C BECK
$422.70
I.E ., RE-'AW.MW
$0,00
'10 DT
TUTAL PY.F-14-ITYIE YIN NOW
$42.2.70
RECEIPT
DATEI
DATE FINALED
INSPECTOR
1.BY
V
II INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
'- BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs I f
Underground Ducts
Forms & Footings I I
Ducts
Slab Grade 11
Return Air
Steel )!
Combustion Air
Roof Deck I t
Exhaust Fans
O.K. to Wrap ! I
F.A.U.
Framing 1 {
Compressor
Insulation ] I
Vents
Fireplace P.L. I f
Grills
Fireplace T.O.- I I
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewalll I
Exterior Lath ] {
Drywall - Int. Lath I I
1 I
1 I
It
Final
Final 11
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs I!
Footings ] {
steel
Electric Bond
Main Drain
f _
Bond Beam I [
Approval to Cover
! (
Equipment Location
l l
11
Final 1 I
Underground Electric
Underground Plbg. Test
Gas Piping
_
! (%
PLUMBING APPROVALS
I �
Gas Test
Electric Final
Waste Lines ] t
Heater Final
Water Piping I 1
Plumbing Final
Plumbing Top Out 1(
Equipment Enclosure
Shower Pans I i {
O.K. for Finish Plaster
Sewer Lateral I f
Sewer Connection I I
Pool Cover
Encapsulation
_
L /3o/OE
Gas Piping
Gas Test j f
Appliances I
1 f
_
Final
!I
COMMENTS:
-. .
_
,,
-
11
11
Final 1 i
Utility Notice (Gas)] 1
ELECTRICAL APPROVALS
Temp. Power Pole I I .
Underground Conduit
Rough Wiring I {
Low Voltage Wiring }
Fixtures �[
Main Service ! I
Sub Panels I [
Exterior Receptacles
G.F.I. I [
Smoke Detectors I I
Temp. Use of Power
f1
11 -
Final I !
Utility Notice (Perm)'
SIZE 18.6
MAI ubs. AMA 41q PERINIEITH R5'
VIUDSILLCROSSECnOri When access IS M2de thFOUGh a mqahboes DEP-Tji-...--
pmpWle it is undemmod that yn-r- the owner- yM.CHQlLiE 0
WATIM w have that mighboes prants6imland . . qgq!73 0
StLL responsibility- COPING CANTILEVER
DATE —---!K'4
(D
vc. 51�' GA S._. Ul- W.UDE sign ature POOLCAPACITY I- t4
DECK P0AF.CAMQITY.,_.. 102 GPM.
2' BELOW HtMSILL SPA DA' %I'
IiI.F* Ffjk.--> MOTOR.HP57A RITE _111pi-5- G)
SEPERATE MOTOR
FL! I BY 01A P AIRPIlE - --'*-kLP - '— " (D
I 11TER . STA - -RITE 30D Sqp-
LINE WrrH OLIERRAM 102
RS . GPM.
ADD VENT CHECK VALVE 32'-0 HEA-EER..LAASIZE r- -
..BTL
SIACK FIL TURNaVER 4 _HRS
A
TO HEATER 2' 13'-7" SLKTION UNES 2 3
Hone 8. RUURN LINE
v
a 0 SK"ER."DDEL
CHECKYALVE. V�P 0
GML EGY SDC _FT_ 95 tj
POOL LIGHT 466W ECcick Tl-6-uiU)
0
ELECTRICAL BY. SDC_ -F.T. z
AUff.QCLkAW 'D
• 16'-2" 111P 0 LA
4 TE 0
r
SeE- —SQ-- 0)
DECK TYPE SALT FIN TBS
STE0 Ft
C3.
SCREENED PATIO %E movib-a A SPA SPECS.
-a-.- -b�I-S—ED
DESIGNER
Ught Stiitch 53 7�
BY OWNER + 12"
___WATTS
SO wiu? S,.V 100
NO DECKING rpi
24"
DATE DAMWALL QUARTZITE
17' 31-6f E�A.% Ll&�Al,!,T2P WAR72�TFI
jnLLIKA��SIZEQIJARyg�E WIDE
E y o REVISED MIX-LI&A—Y)g�.OPEN IJOLEQ
ze IT L
UILDIN R
P/L r CE.117URY.FOOTE7_18ERVLAN CD
L4
Adftw':1 PISCFjS .4
OD
.7 APr-Fm E TRACT STARUGHT DUjNTS LOT* 13 ID
FOR CON' EVE
(A
N
qo jog rm
0
q BA DE EUS 13 poo/s
(-DN
SLID YET PALM DESERT TEMECULA
C'IX vb 1! 111 1 %A uncoAgaimoul COUNTRY COUY 289 10 RANCHO
Im w ..•r..-- n9u ff;6.R i8*10) CLU m STE FA CALIFORNIA RD.
il", 6, rcr- "Wal_'�CALE PALM DESERT CA. STE 203 * 'o
XND F0160"fUlkE 922GO TEMECULA CA.
WiLL-- N 92590 (s)
et •:.-. - — — �162!'WMMWV2 f9m)fim-SWI K)
- --- %--mllu AKt lNor ON
THE SITE, FOR A SCHEDULED
INSPECTION.
EXCEPTONs!
C