0004-160 (RPL)LICENSED CONTRACTOR DECOARATION
I her6w 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
�7 •1?.'7 A
Date �%r �� F Signature of Contractor's -
OWNER -BUILDER DECLARATION
r -
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:
() knave 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".370oof 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.
µ:._ 9TA.TZruNra 046-00-000%)34
(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
IC-ode;"I shall forthwith comply with those provisions,-,,.. ,`
'4D`ate: W,/- Xl 'i -Applicant -11?
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
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
PERMIT#
BUILDING PERMIT
/ r
DATE / / / VALUATION LOT OW4-160 TRACT
0
�q h
eD I M00
JOB SITE
APN
ADDRESS
78-451 PCWHER COURT
OWNER
CONTRACTOR/DESIGNER/EN (NEER
YJM.8EARDK9Y
STM, DoU: ou t°:Ol`i:1`TRUf'`I.ZOA7
78.551 POMFYF!:I COURT
'13011 COUNTRY" (;1X:F3 DX,131'. Trr3; P4
LA QUINTA CA 92253
PALM DESERT
CA 922661)
V60)446-4032
CBLO =V(144
USE OF PERMITe-
POOL AND101Z SPA
*
4 r
POOL & SPA ONLY - AL.ARMS%ARR1IKn SHA A, RE IN PLACE .AT
VIA�
PRE -PL AVTER. INSPEO I IOW,
VALUATION 21,000.00 I'S
ES- MlATM COST OF O(?RS"3VU(7170N
21,OFt00)
1~''tl'd11T FEE i O'Bt�Mrty
PLAN CHECK FEE 101.000-439^318 $140,40
coNS`rkU€:TION FEE 101-000-418--000 $432.00
A-ECI1ANICAL FEE -- POOL 101.000.421-000 $24,00
ELECT RIC 1, FEE. -» POOL 101-000,420-000 $45.00
PLUMBING T+EE -- FOOL 101-000,419=000 $27,00
SUB -TOTAL CONgr,:-tuc�tcaar P 1 it s
e .4c�
I. -93 PRE -PADS FIM
earn
TOTAL P MT.MEN VUE.:
RECEIPT
DATE
BY
DATE FINALE D
INSPECTOR
%.1
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 Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
n .
r
Underground Pibg. 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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Pourer 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)
Final
COMMENTS:
12.6' X y
_i0_:..
'. r t ruFIN1S}x� tpbasln AREA 302 _..PF37METER BO.
lower \ - - .pEFTm 3x--
,,.� Gain . 1 ply a :s �. n..<tooe cls r�the o,g LLLLH9uCE —P_3�0 7�,
DECK ±•ova that as��fu. oornecc nss arrt �—•.. AI [yam_ _ 12'®al B'_ A
`,��
t, .• IN—CAN7'7lEVElt ----- .1-
t DATE_ signature PQ4LC8QACmf.----�.45Q. SiALS_
3Jt P G9➢P�Y— 103..G?$4 W
REVISION ALERT M�T�?_ $TA RR :._ HP1-s m
. P061 wates MOT m
4'-0' (CORRECT ADDRESS) STA RRE �QQ__ FT m
" FLTERRATE _1.. GPM
' AIRPIPE PALM SPRINGS GOLD HEATfR tAArzc aye 250 _@� N
.. ...... 24' , _ _ .._. a BORDERS MIN 24' - V 2 H A
/ P/L y,r. cLrnnN LNFS..... — 2
+6 +lG % RR RU►�S --- 2 U
• i- 7'-0- S' 2' OFFSET - slc,rl a MDDEL AMERICANtj
- 3 .
CHECKY6LVE YES _
fr WSLINEBY SDC _-�- 130 0
HANDRAIL `` PODL'i lsxT 40D w CLaac °
i
install
fitstub 7'-0 \ NOTE ENLARGE 1ST _ ' — PR/ ` ELECTRIULBY. SDCFt
O fA
9 STEP '-9 ' r.. °
for lite 1 s ` � 3i'-0' — /J�� C
z
• pole - 4 _ ---- - - / TER wFiTE - V
SDC S0,11028 0
!,! DECK TYPE SLT FNSH SO BUFF °
2E2
r
.. - - -- STEP FT. N
) SPA SPECS
^, 3' OFFSET <6♦-O'> — FFSET DES1cvER SIZE 7 RAISED- .t B•
- 18" OFFSET
.$'-$' _ DATE DAMWALL 12' X 10 FT.
S ^!. s Z-28-00 DAMWALL TDP TILE .
•y m - S ,.r S 5 111 WAY SIZE 3'X IZ' . WIDE '
f MORNING SDEWA X TO REVISED
P/L i ROOM GARAGE DOOR BY SDC
MASTER LIVING ROOM _ am.,00� __ f
:ROOK P I -s AQUASWITCH G/E e 7e 551�POWErCDURT m
v� LAQUR�A i
f.
KITCHEN IRAQ BELLA VISTA U2M s
a
' A. — -'-- 64'-0' 1 3' WIDE
i
OD
BOBCAT ACCESS m
P� �.
R&R BLocKwALL RESIDENCE PALM DESERT. TEMECULA
g•-0' —�: s N 73-011 COUNTRY 28910 RANCHO
�i ♦ \ 1/B'_l' SCALE 4118 DR. STE F-4 STE 208CAUFORWA RD
_ _ PALM DF5EITT' fA - T1?ECU-A CA
i
NOTE: E FURNITURE 92260
. - • f HO R ILLUSTRATION (7601 a_ - a6-4037 92590 ' cwM
'�/ (� - O A NOT INCLUDEDLC 0 A-574127
Ci / �dFtA TA
A Ki f 11Y$ RE or no
BUILDING & SAFETY DEPS K IFym,m% E� N
APPROVED
FOR INE Sm FOR : t S Q
CONSTRUCTION
• DAT' � � �1V � •