0003-109 (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 # L'ic. Class Exp. Date
3741277 i A, . 08/151/20(
Date. + Signature of Contractor r
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' ��•++. p Policy No.
f1.AG 1TL'ND.e � r _.. V�ti"V•J^TJ11•Y /:':M'.:t
(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
`% a ^-
Code,,I,shalJ.forthwith comply with those provislons��i
Date: a `! • �' `.� Applicant `. y .'� . ✓ '�
r
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` t
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 Y
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.
) q
Signature", (Owner/Agent) `tel ) y (' `Date
BUILDING PERMIT PERMITk
,
DATE VALUATION $20,440.14) LOT/3 - TRACTJOB
SITE
ADDRESS "T&S52- VOWEL'(, COURT
APN
I r
OWNER
CONTRACTOR/DESIGNER/ENGINEER
llrr) A.4 A t'j T
\ mi \rc, ly-m-1sahr r4nnrc•rpy tr-T wr- �r '
ULSUVi 11.1 'i
OJL, � _1S -MJ Viv �,1•40t•. V4.,. La..r:t•�
P.O. 'BOX 751
73011 C;OUN 1RY CLUB DR., METE' P4
RANCHO M1IukG.E CA
.t'KLM DESP,t�' .' CA. 92*260
(760)346.4032 C13LTr .1044
USE OF PERMIT
POOL ANDIOK SPA
POOL & SPA 0. 1.X- �L f1'ttl�4;�F��1�12u' sfV*LL z3E !AN PLACE iv
I�K:};r'NLAN7`J� 1h3�f�E;',"I'fttiv. '
r'
ti'1i.% iJAs[O� 20,440.00 LS
t *.A r.y3A'A-aB9rn@POti.�lA��rp5►R
•'S\"..r"Ai' a;t\lIi.tNV '
Vt7
Lp/ftio .0 A0 .tinV1b3f�
eeyy `(' 'j[,� a '�•y f ��yG ,y E
.J.4 YJI%�IY. �.� 9. •9R:/.st! •��lYi.�dt�.`�.11�? .•
1
KA_N C HCC;K:FEE 101-0* 439-318 $140.0
�►�`;':f ttFc:,10N rFF 18,00N3
�vLr�"1�t:1NI� a�.'d�� �- L'n+�Lafl1-100-del-UO'•�.. $'��.Atl
,
El Wi-TI21CAL 11��ETE •.-yY�OO.L foo-f00�(0-/1)c(U�-rl��[l�y0 $45.06
P1XN1 1'NQ.f•F•c•: `-' P001. ).01-000-419-000
j
r
ANDPI.PNt "If -v<'.
.
X457.40
LESS ZE
1*(Y.i:'A1:.'P:*,'PA%11:1'I+Z?; DQ.)ti'NOW
S,452.40
RECEIPT
DATE
,BY ; ('
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulaton
Condensate Lines
Party Wall FirewaI
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
8
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING- APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
_ p
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Condit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
sv' .
CONTRACTOR c2mat GENERALSFECUTCATIONS
�• dd.a e.....e Ia,11I1itfelP fry b.irr, cement SIZE 20 X 32 -
M — RI.A. • AREA 4=7 PERIMETER 92 .
w]ft sprim$ wm ldc9hom ine or shn—hs
61 - When access_ Is mode thrwgh a nem= o'`- DEPTH 316•c5a3W .
6' Fa 2F_3 . _—_ _ f�Ily d is �...�..�s....•t • �t vnu_ the ow�.r- 3 SQ 6836' ...
• 4'
___.._.._.' CANTILEVER
5,, -----._ —�-�—� --•--'— DATE signature POOL CAPACITY izaoo ..
PU14P CAPACITY101M
P
NOTE: REMOVE STOOPS `' MOTOR HP -STA RUE— — u
?P y, \ - MOFORI$
- 3 FILTER STA RETE 300 SQ FT
14'-9�.6e 76ta •. jj � .
:A'-0• - • I �.� UGHT SWITCH _FILTER RATE 102 GPM
_ - -BEATER I AARS S7F 4DD.
N _ 'd' - -- - - - t - RA rIjRWVER 2 HIRS-
N
F1��y. r SUC1tON LINESREFUIN LINES .._
7 - _jpV
AMERICAN ..
M yCHECK VALVE YES
61 . PIA t. GASLY'E BY SDC FT. 140
p- - - FOOL LIGHT 400 W CLOD( T104R
PYA ELECTRICAL BY. SDC
Om t - AUTO CEeMifffimmmm wm�
• RESIDENCE SOSQ•
PJL .. - - - DEO( TYPE SILT FLASH NTRLGREY ,
_ _ - 8.6• i y . _. a _ F. / , - - STEP SPA SPECS.
- � - moi• . DESIGNER SIZE ) • RAISED YESW
LITE 100 WATTS -
TOM ti LEVEL SEATS 22.24` 27-
.
' J _
O q :` . Q. DATE • 10 F(.
DAKWALL TOP 1
O\
IL BLOCK EQUIPMEMT WAIL .O. S �. . It -17-v4 SPILLWAYSIZE 3-X ,12• • WIDE
Z . • _ BY SDC • .. - - '� - REVISED WAY XX OPEC_ (� _
O,' tea'
0 _ - A y Llame: DAVID AND BARBARA GERMAIN.
0
AddLffiS: 76.552 POMPEII CT +•
- V cipi LA QL'L\TA •
Kw Z a U
BOBCAT ACCESS - .���
(3 . R&R FENCEU. - r
ac w m _ POOH
a
PALM DESERT. TEMECULA
_ w 73 011 COUNTRY 28910RANDIO .
NOTE: LANDSCAPE ANDIF1JRNli�1RE 1B'=1' SCALE PALMR. ST7 F-4 - CA Zp6"A RD
ARE SHOWN FOR tLLUSiRATION 92260 1EMECUW
a ONLY AND ARE NOT INCLUDED.92590
s.