0010-067 (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 # i Lic. Class Exp. Date
.514.1 Date 1 - 4j Signature of Contractor__
77
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.,
( „) 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).
( ). 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' compensationprovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those p,roo• visions le/.,
Date: ! .•9 a�f, Applicant/ ..,� "`- 1"'" F% ( -•--__-_---~_,.._
Warning-; Fail re 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 inspection purposes.
Signature (Owner/Agent) •+�"``�-""" "" """Dated rt1
BUILDING PERMIT PERMIT#
DATE f VALUATION LOTTRACT
JOB SITE i
APN
ADDRESS'
OWNER
CONTRACTOR / DESIGNER / ENGINEER t
3gq1fs'y°ay M:tit,CUrTa
MINE "DODSON C'i{)�)3�•{�{'T2�q.�q:1�C'.�i�t!y�FINC.
.yyy'� �+
9w"6s70 F13G 0 �i�.a'11.0.1. j�
710 Y03 1 CO��:'`E MI ':i CLUB DR, t i11.1y E d 14
'LA Q�)I +1TA CA. 92253
I-Ij m 1YL'31::lr T :CA. 92260
(760)346,4032 (MV0 1044
USE OF PERMIT
d7101, fiaMfRSF
POOL & SPA G:f?4D..Y,-A1,A1;MSPF..AA1UF RS SiFa.A:4, BX 1N In ACZAL T PRIZ
PU. ST ZA IA3SM4,410, W. POOL WY1'ARY;We
114 THIS MMIT
x
POOL ANNOR SPA 1,ot�,ii4
E'SMW XD COST 04; :-`.`rA'XVfV7X ``rL0X
F.g�l!•+.,y�+�A�,
'fir FRE it1���YUMNLARY
f ) !� �. ! /1 1 g W0,40 t C f� !�f
1-e AW ("HECK P 213 )OI"4�ti.711^'439--31O 88"20,"70
OfJNSTTLUCTI:,3'N ME 101-000-418-000 10216.00
MICHMICAL PER — P041. I 0 000 -A2.1-'000. $701.00
trt,.liG•J'1'i.f�'.��.i ; a��; �� a>�"•�a:.' • • ' � iit-{�ti�r-���• c��e ��. fi0
PLUM91140 RZ POOL 101-000419-000 V70
,.
C0111S'1°17t2•C''9fiI:i1+ 'Ab?D PIAN CHECK
$452.40
'L EZ15 PRE^;k'/M FEW
$0100
t ,
TOTAL PEW U re DVENOW
RECEIPT
S
DATE
BY
}
r�VO
DATE FINALED
INSPECTOR
'
n
f i Ate'. C��.
P.
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Bond Beam
Main Drain
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
Sewer Connection
Pool Cover
Encapsulation
1l� 1 �� CPO !
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
p o &
60
1 �S
at
Finalca—
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR, A SCHEDULED
�L�A�,(QUINTA
ITYO�F
r-c:Ty nEPT..
BUILDING & ZZ)tA
APPROVED
FOR CONSTRUCTION
78.
DATE �00 �13y
A
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PIA
PIA
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BACKHOE
ACCESS
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Jf
when
WoMy it Is Lrdemtood that ym- the oNnir
have that ne boes p=Issba and assume full.
I DATE signazure
P/1-
RETAINING RAIL By CENTURY
•
STRIP FORM
FINM WrFIH STUCCO
16-6 1
0
AIR PIPE_
NE,
3 RA140YIWA
-ZATE
i Z i4
DECK
17'
380 PEMYETER 86
DEPTH 3' X S'
—6
0
RBB. --
CANTILEVER
CANTILEVER
POOL CAPACITY 11000 GALS
PUMP CAPACITY 102 GPM
MOTOR HP STA RITE HP 1.5
MOTOR HIM - Hp
FILTER STARITE 300 sQ Fir
FILTER RATE 102 GPM
HEATER LAARS SIZE 250 BTU
TURNOVER 4 HRS
SUCTION LINES 2'
RETURN LINES 2;--
SKIMMER MODEL AMERICAN
CHECK VALVE YES
GASLINE BY SDC FT. 60
POOL LIGHT 400 W COCK T-1048
ELECTRICAL BY—CDC FT. 21V
AUTO CLEANER
MEN. fflM
TE
DECK BY SOC sq110D
DECK TYPE SALT FIN OMAHA TAN
STEP CONC FT.
SPA SPECS.
SIZE T RAISED -18*
LITE 100 WATTS
TRI LEVEL SEATS 22- 27-
DAM
LACIMMABOMIES DAMWALL TDP Q
MIL11SILLFFrIUM 8 ---,.CLW
SPILLWAY SIZE QUARTZTE YYIL
J Y REVISFm-D XX OPER CLOSE
—Uff!ER Ljowl
Name SAM AND RUTH MARCUS
02 ..
DECK
17'
P'6790PIS-CF.-S."Z�'
If
2'RELOWNILMISILL I
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SLEEVEALL
STARLIGHT 13UNES LM 12
PLANTERS
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ROOMT do STACK
PALM DESERT TEMECULA
g TO HEATER N
73-011 COUNTRY 28910 RANCHO
118'=I'SCALE
CLUB DR. STE F-4 CALIFORNIIA RI).
STE 206
ANDSCAPE AND FURNITURE
PALM DESERT CA.
92260 TEMECULA CA
RE SHOWN FOR ILLUSTRATION
fz6al 46-4nl;92s90
(9.093676--liwk