0310-316 (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 # Lic. Class Exp. Date
656I28 C53 :SIC C-84� ��1p ..1/2(
A/C
Date �� Signature of Contractor �+,�
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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.
Se).r I have and will maintain workers' compensation insurance, as required by
c ion 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:
Carver STATE CC7MPE14SATI Policy No. 046-616.34003
(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 pro i ions of Section 37009
the Labor
Code, I shall forthwith comply with those provisions.
Date: !j✓r Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation c verage 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 it
a. ,. .
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 1representatives of this City to enter upon
the above-mentioned property f�c, Inspection purposes/
,12
Signature (Owner/Agent)Date
B;U,L-DING PERMIT.-. PERMIT"
DATE _.VALUATION LOT 0310-316 TRACT
$1'7 .75 143
JOB SITE
ADDRESS 81 715 P7EJSM. DId VE
APN
OWNER 2+'"
CONTRACTOR / DESIGNER / EN (NEER
81117EAH01" i
CMZ,01 1,T.1APOOLS & SPAS 1;I'OP 1v2W CO
81.2.60 AVIWUE 62
66.100 AVENU9 54
LA. Q1A CA 92883
CO ACEW-U A. CA 92.236
(760)396-9222 C:BRL/f 00355
USE OF PERMIT
POO.L AM/OR 11WA
POOUSPA,BAQ, & 15 V. g' HION B1,OCX WALL.. ALARMSOki'•"Mm
SHALL 8E rN PRIOR TO PP -PLASTER INSPECTION
5 PT, WALL 16.00 LP'
POOL, A2d$Y'OR SPIT 17,6fi3.f1D Is.
E9MVL:= COS' OF COINM' JM1 10.N
ARY
3r'la+ 3['T` Y .101hWARY
PLAN CHECK FZE 101-000-439-318 51 hags
CONSTPLUCTION FEE 1014100-41"00
WWRANICAL IFEE — POOL 101-•000-42.1.000 $24,00 .
ELFCTRICAL PPE — P130L 101=000 4.20-000 $45.00
PLUMBING F&W— POOL 1.01-000-419.000 $27,00
,
® i'OTAI, I`$u�€It7iTG:TJO1`T�JD1'tJ�i t"`FiF,f�:.
$4U'�r.E3S
'
j L,SS 1'RE_.1?A!'171WZ
$0.00
N10 0 5 2Q03 -TV
fA 1, F%1?.1t+. r . ' S DU7E
CITU OF LA OWNTA
FINANCE DEPT.
$40725
RECEIPT
DATE
' ? '
BY
SFIN
INSP TOR
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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
POOLS - SPAS
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
Final
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 Powe±
Final
Utility Notice (Perm)
COMMENTS:
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SPECIFICATIONS
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TYPE .SIZE X
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SLIPrACE AREA OF M
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PEPIMETER �� j) I DEPTHS MIN �-e MAX. �
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SPA SPECIFICATIONS
SIZE `l G� SO FT ?t7 13
TILE
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Tits TYPE _ t� P •+ lSnT LI ,J
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SPA DAM WALL WIDTH
WATER LINE
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NO OF ITS
TILE TRIM
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LIGHT r
QUA ROIE ND
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RAISED SPA AT
RBB. T
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SOILLWAY TYPE �'' ---
d N
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SPECIAL NOTES
in rn N
DECKING
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EXCAVATION /t7STE
50 �Zjtttai
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TYPE ►S�{
ACCESS FROM !, ('4_ T I,.+
MkMON JOINTS _
0 Q
V
ELEVATION
CANTILEVER
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DEET' EF7 RAMP
DECK DRAINS
0.
LCV= SEAT
DECCO DRAIN
CCNCRE'E REMOVAL LOADS
CURB CORE —rte
SOD REMOVAL �^ LOADS
STEPS
TR_m REMOVAL BY
STEP FACE
IR7IGATION REMOVAL By _
TLE BASE
D t
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IRRIGATION REQAIR ��,..._
SAND AND VISO`JEE'I
6' RBB
"VONT
'
12' II
Mow S'r'P
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18' RBB `f r ft
24* REIS f4_
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TAN 5t -W DEPTH
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MASONRY
s
POCK POCKETS
COPIN', TYPE
'
R B B FAC"S L
SPILLWAY TYPE << ,� SZE
PLUMBING
STEPS
l
FILTER Cl; tJ { g
POOP EXT WALLS
'
POOL PUtra SZE �^S
PLANTER WALL
RETANW, WALLS
BOOSTER PUN° ``-- S! 'IT �"�
ECU'O WALLS 1JC11)�
ADD'L PL't,R+ � SIZE
FIPEPIT V;` 4 1 `' i ww ♦
+
°
ADD'L PUMP
'
HEATER . JA V C S= fa'Yl
TIME CLOCJC1?
SUB PANEL
Sr'M11ER TYQE
Fiat LINE r_# 1_4 Vc`t :
PEBBLE PLASTER
_
{
SYUPS
UGt•TS POOL
CAS lN+'
LIC✓'S SPA 1�0
FC1t4TAiNS/$P9AY4F_ADS
POUED B NO PEAM
FEH'N;, SPA ir,--It
St+FiR DES CIS _
,,,�t4fs
EY;"ALLS � is
LIGHT'S IN POOL -' r3li N SPA IS-()-
STLn SET EOVr" NT ` C
M1PC
PLUMP+', SZE I ►
HElCHT
WE
GUNITE
CxTE RE'^^_AL-'
o
DEEP EPI PAVP
EXTENDED 2rd STP
LOVrSEAT
,r,P!LLwAY TYPE
EtT START
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coot",
OTHC:D-
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R P S - SEE STE -_
tOWNEk
MPONS19 L.I 1t S
'
OPIER TO (I) DEr.PiONE T3'' APPRCrMATE ELEVATION OF PML. OR SOA AT LAYVJT ON DAY OF EXCAVAT ON
(2) TAVE NOT,CE THAT POOL AND EO+JIPNET LOCATIONS AP: SLS,F_CT Til ACCE°TA*CE OF
LOCAL BU'LDNG DEPARTME'JT AT TVE OF MANCE OF PEAM+T
(3) WET DOW4 CCNCPETE S�rLL AT LEAST TW0E DAILY FOA 5'VEN DAYS A'x•TER $HELL IS We-IrALLED
(4) AGPEE THAT CAUrCP41A POOLS IS NOT RESPC`iT,9+_E FOR UN^E'PGROUND C,-IMTI'JNS OR OOJECM
C�
• AND ANY CAMA^.E TO CURLS, S:DEWALXS, W',SWAYS. LAW'IS• OP CNrP REVS IN TN' ACCESS ARFA
{S; SEE THAT ALL FENCINO CATES, AND GAPA-r D1YY 5 MEET LOCAL CODFS FOR A POOL E t -os RE
O
P*'OR TO Pr,'r_'+..ASTEP NS^ECTION
(r} FILL POOL IMMEDIATELY AFTER PLA"_ (FOLLOW INSTRUCTIONS +- DO NOT USE RU99ER HOSE)
(7) TAKr NGTICE THAT T+"S DRAWING IS THC SOLE PPOPERTY OF CAUFOPNIA POOLS AND THAT ANY
V_E WTNDUT WRITTN ME WS90N OF CALIFOR`AA POCLS, INC. IS PR"TED BY LAW
OW4FR APP°OVES PLAN, POCL, AN^ EOLRPVt_NT LOCATIONS AND HAS READ THE RESP01tS8'JTES AND NOTICES A509r_
m
S:CNATLNF(S} ATE
SWI M M'NG PCOL PLAN FOR.
Nr��H'rvl I STOP II0 RE IDE CI
STS EE T �- l�
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10 n ADDR S ", i0TY
C.SI..i0N 0 `{c 1 Rr_.SS��i~r�6,
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'ORS,,`,"; BY ` 50L0 E3
CHECKED BY
10 _
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REFI S -I ON S DAIE
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_cT rT0F1A-QUINTS
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BUILDING & SAFETY DEPT.
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3
APPRO
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.---.FOR-CONSTRUCTION
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SELECTIONS a
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"CONSTRUCTION AUTHORIZATION
STONESALES
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PEER /PLAS
1,11ASONRY
SIGNATURE
_...-
DIV I:
Orcinaae and irrigation for pianterS and pots, by
PRT:-I'113131.I:
CP''INAG` N0 TE. 0*i ers, unless otnerwise rioted.