0312-169 (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
656) 28 C53 Inc C-! 10I',112(
Date a•1 '0 Signature of Contractor—
OWNER-BUILDER
ontractor r �-m
d
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.
(v�) I have and will maintain workers' compensation insurance, as required by
SI'd on 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 STATE COMi3KNOATI Policy No. 046.6169_2003
(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.Xisions of Section 3700 of the Labor
XWarnCode, I shall forthwith comply with
T a thosrprois/ions.%Date: Applicant
VX/-
Warning:
ing: Failure to secure Workers' Compensatio,lf overage is unlawful and
shall subject an employer to criminal penalties and'civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property 6 inspjection purposes. ��yy
Signature (Owner/Agent) / / � -• Date 12 22 -
f 'L d''w t .
~�� BUILDING P_ ERMIT PERMIT#
0312-169
DATE VALUATION '« LOT TRACT
JOB SITE APN
ADDRESS 410,x3W-PW !1M_4 .P3FAR LANE
OWNER CONTRACTOR/DESIGNER/EN (NEER
SH i IO1v!aj;5
81-260 AV,�i'U9 62LA QURTfA
USE OF PERMIT
POOL ANWOR SPA
86.100 AVWOR' 5R
CA X29 a C:OACBEM.A CA 92.236
(760)398-422.2 C81JI 00355
POOUSPA. KfVA. EIRPPLA.CE PK.APR1Z0VFD DETAJU SI3Q(ANSI
ZV-358,-1995) . a U. 5' BLOCK WALL, CITY STANLDAPJJ. �
ALARMSf$ARRVEitS SH&LI,.;HE rN PLACE. AT PRZ-P'l,F'�'t'ER i3JF1 I
$ P'I'. 'WALL S,00 is U
POOL ANI7.IOR. SPA I9,z92.0t1 LS
CI'
mII45f.ACI° w C®sT OF cojonw6woiq
PLAN C )iECX VER 101-000-439-318
CONSTRUCTIOW IFFI:E 101-000-418.000 $21COo
M,ECIHWHIC'AL FU -- POOL 101-000-421.000 $24,00
ELECTRICAL FIDE - POOL 101.000-420-000 4100
PLttidlBINO FRE -- POOL. 101-000-419^000 $39,00
SIM -TOTAL COYAHITRUl"1`ION AND K.ANd 03.EMC C
LE33 PRE -PAID HTS
T(? f ffl, F SlO.`I' 171ES IMF, NOW
=C 2 3 2003
'OF LA OUINTA
DANCE DEPT:
RECEIPT I DATE I BNS J ' -�F I DATE FINALED' I INSPECTOR
L /-/
2 tJxQYi.•V.2.5
$452.40
$0.00
S452.40
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I.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 Q
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 Power
Final
Utility Notice (Perm)
COMMENTS:
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CO L.l.-Iz Iv D C.^LT CON CFS TJE` !
NIC WIL SS'U, r�9 )A, -NTT' Fir \1r-iTE�P
t SPECIFICATIONS
TYPE �'ut4K£ SIE X 14'-Q``
SURFACE AREA OF POOL 3'
PERIMETER DEPTHS MIN t' MAX'-�jj1
SPA SPECIFICATIONS 7U
SIZE I O X .(0_ SO FT TILE 1`tR
SPA DAM WALL WIDTH MATER LINE
NO OF .QTS TRIM
LIGHT Z QUARTER ROUND
22+4 �+ P-88
RAISED SPA At
SPILLWAY TYPE
SPECIAL NOTES
DECKING t�5o
SO E
EXCAVATION /a TB af'< FMSHTYPE
5 th" 12'' f_t >1~ GA�►�
EXPANSION JOINTS
AccEss FROM C. Ge
ELEVATION 'f d CANTILEVER �r
DEEP END RAMP
DEd( DRAINS
--
LOVE SEAT DECCO ORAN
CONCRETE REMOVAL LOADS CURB CORE
SOO REMOVAL LOADS STEPS -�
TREE REMOVAL BY �- STEP FACE
IRRIGATION REMOVAL- TILE BASE C.
IRRIGATION REPAIR _ SAND AND VISQUEEN
6' RBB " RIBBONS
12' RBB (� ft MOW STRIP
18' RBB ( k
24' RBB. f -----
30' R88 ft
TAN SHELF DEPTH v i
RM R
COPING TYPE
CENTERS R SO. FACING QI'J
SPILLWAY TYPE ` !'' 5112E
PLUMBING STEPS
FILTER
f --a , ;F gZE t t _ T PROP EXT WALLS -
_5..,.E3�� "r
POOL KW C q ` SIZE PLANTER WALL
RETANING WALLS
BOOSTER PUMP SIZE EQUIP WALLS
ADD1 PUMP SIZE FRREPIT 4jok P (At'4
ADD1 PUMP SIZE
HEATER A L -t 4:= SIZE Z4-06
TIME CLOCK 6044 OAJC no 'r -x,.44 he -c- A I
SUB PANELID.JC ,K
AODM 0
SKIMMER TYPE �••
FILL LINE �f) rS PEBBLE PLASTER
CAS LINE �t°STUBS 'f es UOM POOL 1 - "3 20 '?
LIGHTS SPA
FOUNTAINS/SPRAY'HEADS'µROLLED BOND BEAM
SNEER DES BEHIND SPA
EYEBALLS
LIGHTS N POOL ! , SPA
STUB SET EQUIP Nor '� F CING
WISC.
PLUMBING 411E t
HEIGHT
GATE
GUNITE GATE REVERSAL
DEEP END RAMP REMOVE dt REtIA `'�
EXTENDED 2nd STEP -
LOVESEAT
SPILLWAY TYPE_ �C-4�'� � EST. STAFYT
`4 EST COMPLETION
CANTLEVFR
- - - COOING OTHER 41
R 8 B -SEE STEEL y ' ✓/ 0)
:a V
OVVNER RESPONSIBILITIES
OW">Et TO (1) DETERMINE THE APPROXIMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY OF EXCAVATION
(2) TAKE NOTICE THAT POOL AND EQUPPMENT LOCATIONS ARE SUBJECT TO ACCEPTANCE OF
LOCAL B'11LD(40 DEPARTVENT AT T VE OF ISSUANCE OF PERMIT
(3) WET DOWN CONCRETE SHELL AT LEAST TTt10E DAILY FOR SEVEN DAYS AFTER SHELL IS INSTALLED
(4) AGREE THAT CALIFORNIA POOLS IS NOT RESPONSIBLE FOR UNDERGROUND CONDITIONS OR OBJECTS,
AND ANY DAMAGE TO CURBS, SIDEWALKS, DRIVEWAYS, LAMINS. OR OTHER ITEMS N THE ACCESS AREA
(5) SEE THAT ALL FENCING, CATES, AND GARAGE DOORS MEET LOCAL CODES FOR A POOL ENCLOSURE
PRIOR TO PREPLASIER INSPECTION
(6) FILL POOL WMED1ATELY AFTER PLASTER (FOLLOW INSTRUCTIONS -- DO NOT USE RUBBER HOSE)
(7) TAKE NOTICE THAT THIS DRAW4G IS THE SOLE PROPERTY OF CALIFORNIA POOLS AND THAT ANY
USE WTHOUT WRITTEN PERMSSION OF CALI'"A POOLS, INC. IS PROHIBITED BY LAW
OWNER APP'POVES PLAN. POOL, AND EOUIPMENT LOCATIONS AND HAS READ THE RESPON51WrE5 AND NOTICES ABOVE
SIGNATURES) CATE
SWIMMING POOL PLAN FOR.
NAME GADOL RESIDENCE
STREET -308 t_ cO f e vf-f ^0sx
JOB ADDRESS -"t: I ' c CITY Z,4
PHONE OFFICE.r6t.- ; 3-2 3 RES -2-48to
LOT TRACT 002 PAGE BOOK
MAP BOOK PAGE N0. 7 CITY
MAIL ADDRESS
CONSTRUCTION OFFICE PHONE NO.
SCALE DATE DRAWN BY SOLD BY CHECKED BY
1 /e"-1, ;i-�,-01,I`v,LY k)rr�
JOB# REVISIONS DATE
1 1!f2 11
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DRAINAGE NOTE:
Drainage and irrigation for planters and pots, by
others, unless otherwise noted.