0010-047 (RPL)LICENSED CONTRACTOR DECLARATION
I h; eby 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
-�
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
y
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
ecti n 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.
DWIS FUND 046-00-00
(This section need not be completed if the permit valuation is for $100.00 or les
( ) 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
Codi I sha I fortwith comply With rthose-provisions
;
D e: � Applicant4. _ �_ •�
t, arning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
u yt
1. Each person upon whose behalf this application is made & each person'at�l
whose request and for whose benefit work is performed under or pursuantto
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is r
Correct. l,agree to comply with all City, and State laws" relating to the building
construction, and hereby authorize representatives of this City to enter upon
the
above-mentioned property foinspection purposes. R.
ti Signature (Owner/Agent),i' ' `` f :'d�•_Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT .1. 47 TRACT
- ~ -
JOB SITE
APN
ADDRESS
43-045 PISCES COTIRr
OWNER
CONTRACTORESIGNER/EN (NEER
43-W FTF,3C•134 C:CYC7ff
73011 COUN RY f.'.,,f'(J—A F4
'L.,AQ-0ftTrA CA 92253
i?AUYIMI +qtr[, ICA ;+92.260
)lf )346.403.'' LS14 1044
j
USE OF PERMIT
%'7.1011 KRD/Oil SPA
P001, &SPA GYW INAY..A .A$Mt'tRR1ERS ISHALI. l3r, IN PLAC:X. AT PU
PI A9`fPM INSPECTION. POO ZQUI9gSltdb:I+ T Y C'•1.0941 A 19 NOT INCl.tlDED
P001 AAI.'bJ0,1 MA L.S
X19M TED C°C,' al ore C9OMIFIRUC ROM
a0110.13d�
P)AM11 CHECK ER 101-000-439-22418 $1423
CONSTRUCTION FNIa ` 101-000-1118.000 $2,%3.00
MECMNICAL FRE •- POOL 101.000.421.000 S7110C1
L1„.tr±C'tWC.AJ,1-FEfr,—P001. A01-vtilCD-X4°2.0--000' SA5.00
PUMABING FE ._ POOL 101-000-419-000 SZ1.0+0
e
a ,
R.'
CFMCK
$467,2
YAL MOW ley—Lis DVE NOW
r
$467.15
RECEIPT
DATE BY �/ 11
DATE FINALED
INSPECTOR
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 Insulatior
Condensate Lines
Party Wall Firewall
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
�0(
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Power Pole
y�Temp.
fiderground Conduit
.4ugh Wiring
)w Voltage Wiring;
}Ixtures
/Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm
a
0
a
• -y�rr
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
)A VEINT
TOHEATER �� y
SET EQUIP. /
`-- +•I V REA R SETBACK r
CLOSE TO SIDE POL
0
:'_'
R-1wail
Li
7 .l
a Ca
FE,\CE AND GATE BY�-=�p" `•c.+� <id..wa0cs dr:._��, ys_aement SIZE _11.6 Ir 30^• ... .—
PROPOSED RETAINING K'AT1. OWNER' AREA_ i�.._PEAIMETER 80'
PraIL .tnriMtivs- telenho �wc er.n n --- BY CEhrrURY When amen is m,d, Ihl,,h�I*thors- D.C'!'LH--- 3 x S _- . ._...—. --
oRylEt(y it a urderstmd that you -the owner_ TRE CHQICL GROUP 3 SQ 46
P!L haveLnai ;iol �pemitrim a.,n Mme full
miCnsiblt06 1iDRW----CA\TILE�_ER- ---
_________________ __ ---__ DATE--- si nature - ?09LCAPAC!TY-__ . 11_AkI.yALS_-
SrACI DAMIEUALL P41�fP_QAPAQT------ l0= -_Sri— .
.. , wtanrolmeetale� MOTOR.HP STARrrE
..nasi . s=_.a r_•v..�
� .em MOTOR -TLP --- ---- --•-- HP _
1
1°�"r`�D`�• FILTER _ .._STA RITE 300 —54FT
e •�..
FILTE8RA3E
HEAT.ER..LAAXS SIZE ._ ?_ BTU
.AM i veant TURN VER._.. ? _H.iS..FtFTLLR
_.
SIlGL•QtiLIIvES------ . .
l8" WIDE
tos WML4E8AWEL_8lEttlCAN
- -
IK_4' SPADAw
' WALL GASLINE BY SDC FT. ISD'
IIP -6" �SE EPATE POOL UGFIT 400 W C1O('•K T701R
3 LINE WITH ELECTRICCII BY, Fr- IT -
CHECK VALVE AUTQSLE�IN�R _ --.- --
�-�_-
PLASTFit
lavtnF r`I ha m: L: '17 _ : . E l:> cat Kaam G.rF DECK EX. �_ .._.- —
DECK TYPE SALT FIN TBS _-
• P1L
K. _ 9 �- DESIG,ER �_ZE T RATS® ♦l8- --
IDENCE r
LRE lD0 WATTS-- -----
RAxDY Rt LEVEL SEATS 22- 24" 27"' -
. DATE DAM WALL QI-ARTZTTE
C DAMWaLLTOP OUARTZITE_—
PIL i+<O[[ lyrY __ 41 1 SDILLWAY SIZE. ..QOARTZrM
•>� LAOUNTAt1DHE5- _- REVISED WAX XX OPEN-_- CLOSE
lases Jif-- SILL CROSSEC ION a JF -TS 4 APER 4QN'E-R
,} -II Ilii• _ _
I U) I BOL'SE Name, CENTURY/CHRIS ZANESCO
r+7set_- !•+ `•I
ES COURT
ACESS OE f I r L t `7... .:::: _ _ `.. ! wnb ' blUD SILL
NO WALLS -III i �!I : !Q �.tftPY I t $al _ _ : J T DECK QC;1tiTi4
Y� ' •._ •.{ ni'*•t_ 2' BELOW %IUDSD,L T�p('T I�DTu 9
1� wdr :' C+amL RtVPt►TiARLIGIR DUNL
Poo/s
PALM DESERT TEMECULA
I� �r
73-011 COUNTRY 28910 RASO
I CLUB DR. STE F-4 CALIFORNIA RD.
l/8'=1' $CALF, PALM DESERT CA. STE 206
TEMECULA CA-
DS APE AND FURHi17URE 92260 925911
A RE-INSPECTtO FEE 0 $3Q ARE SH, wTv FOR ILLUSTRATION (7601346-4n32
()NrLY A>':VD ARE LOOT INCLUDED_ . , .... ......fiZ5S�
PUNS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
NO O�EPTtONS!