0203-221 (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
06128 0113 110�
Date 2 ,31.. Signature of Contractor
lir/
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.
' ( r) 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 >FfATE COMPF" ISAT'i Policy No. 046014%168-0
(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
Code, I shall forthwith. comply with,thgse provisJons'. f
Date: 1 7Applicant ,#
2 r
Warning: Failure to secure Workers' Comperfsation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code,. interest and. attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. r' 'x
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of' such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building "
construction,.,and hereby authorize representatives of this City to enter upon
the above-mentioned property,for inspection purposes.
Signature (Owner%Agent) �� r k/'fi t. Date 2
y
#)BU'tLDING PERMIT PERMIT#
DATE VALUATION LOT 0,2(r" -""'t TRACT
JOB SITE i�APN
ADDRESS LA QXJMT77AAR1W
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T. D. DMi ELS��-T-YEV11i.C`1M"f
/ J<'s.I.S.a}�1 Y' «�C9�tiil.� & _V ASS CDO!� civil?
P.O. P-C)x 1716
74725 ,fOR1. DIM -4 ;I'CE12,;$ A
LA Q'M--rfA C,tP, 9225'S
PALM .1+)Etl�k•' I CA 92260
(760r.340-9000 CBLO 00355
USE OF PERMIT
'DOOL A /00, 21PA
<
11001, SPA, HBQ (ANSI 2.21-$9,19 5), !a.?,,,R$:MVBAitiRI--pI"S MALL BE
W PIA -V? AT PHZIPLAISTFR Iltil P.GrICTiON. POOL ZQ)XJIPMiNT
A'#�tCI. {313J'Jt.� 1dC5`P ��it:i.1JOG�0
VAIN ATJO a W
kuS"y$Ii'�tr3�ll'fII
P.k%MT FM 81fi3MMARY
PI AIN CHECK FIR „ 101 X000-439-3118 $14M.
0 .
CONSTRUCTION Fk,E=., 101-000-4,18-000 .iI3
.
MECHANICAL J? •5-�_i'�OOL : IS➢l-!}OC�+4.t",1-00 q $�244:fCt*3
.
i'..�I.�lY4.s .8 RIS..Al- l` Z - POOL 101-000-420-000
nuMBItJcT �t,1�'', P0 (Y, 101.000,419.000 Sri,
0
MAR 2 2 zoo'
# ppb Rp.�
Cao
ftt+w
9 �ra'�.d�eNTA,.
Y
e `.1rki=6� 1'.f�ba oew.07w'52.40
I JE 3 a�itl Fin,
.9 $0.00
TMAX, PEW.MMS DUE NO
A0
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 & 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
— g -
Footings
Main Drain
- L
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
-
Underground Plbg. Test
Final
Gas Piping
8 —
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
t, Plumbing Top Out
Shower Pans
Equipment Enclosure
O.K. for Finish Plaster
+
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
5
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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SPECIFICATIONS
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SPECIFICATIONS
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EXCAVATIONTEFL
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° BATH
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SPECIFICATIONS
TYPE ' `� StzE x
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DEPTFIS MRL XkX.
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SIZE _V x go fT.
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RAISED SPA AT
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TYPE � C" -.Jr-
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ELEVATION • G .�! ♦
Delp vo RAMP
CANTILEVCRV PU•s
DeGK oRm5 OJ O .nAELiti-
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(
51
PROP EXT Y44.LS
PLANTER MW.L
PLUMBING �-- '513+°
PFILTER„,,-
POOL P * Size 2 '
PUM
DOO67T9[ FUMF ” Side
p'
ADDL MW !SIZE
PAUIP. MALLS ..
AWL 01" elm
V ,� P, �t ;Z5
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HEATER 621! Loa0 O Q
TRIC GLOGK ,.J
LUB PAM.°
ADM
SKe•�NCR TYPE O�
rlu Lne �_
-
PEBBLE/PLASTE
06F+TS POOL
*AS LME STYES
L16W S SPA
FOUNTASS/SPRAIWADS
ROLLP.D E{OND BEAM
'
WIND SPA
_
tSHM�`t���
L*" IN PMOL A`2?tN 9'A
EYEBALLS r
� �
f" ter ew 4NT " "'� '��'
"Sc *
PL:d'IBlrib SIZE Zt � •
FENC INC
Pere TYPE
H6HT
t7
.�.,
OATE
SUN I TE
6ATE PZVERSAL
MEO m RAW
REMOVE ! R£H
'
EXYMVED Ind STEP
LOVtSEAT P,.A
esT. START
v
,�,,� /
SPptylAY Q,Al �T
^
GANTILVER _
EST GOMPL.ETION
O Q
coPCNd
OTHER i
RDD - 4lEe 9TC!L �'�"�•`
OWNER RE5PONSIBIL TI
r
&,,+ R TO, A) A vrmiRmw Tw APPRoxmiATE rLEVA-ncw OF POOL OR SPA AT LAYOUT ON DAY OF EXCAVATION
(2) 7Ake NoTta THAT POOL AND ECiAI"w LOGAyi" ARE miecT TO ACv!PrANCe of LOCAL
�
LOCAL 1911LD!Nb DtPARI1�TIT' AT TiNfl• OF ISSUANCE OP PERMIT
(3) MET DOM CONCRETE SMtLI AT LEAST TVIGe DAILY FOR WAN DAYS AFTER SWELL IS WALLED
(4) AORM THAT CALIFORNIA POOLS 15 NOT PrSPiONSIDLE FOR UVERB+ROUND COtOWNS OR OSZCTS,
?
AND ANY DAMA6E TO CURBS SIMIALKS, DRIVEWAYS, LAMNS. OR OTHER ITEMS M THE ACCESS ARIA
C3) SEC THAT ALL FE IN6, BATES, AND OARMe DOORS SHEET LOCAL CODES FOR A POOL E W-LASt1RE`
"JOK TO PREPLJST e R MIwwrlON
(6) Fu POOL immmmwr AFTER PLASTER. tPou4m RISTItxroI s » Do NOT me mzm Nom
(T) TAKE NOTrX THAT TMS DRA" IS THE SOLE PROPERTY OF CALIFORNIA POOLS AND THAT ANY'
USC KIT14AT WRITTEN FERMIS3fON OF MrORNA POOLS, MG !S PROtMVITED DY LAM.
I
OWNER APPROVES PLAN POOL, AND e0U1PMeNT LOCATIONS AIS MAS READ THE Rlep"IBIL mft AND NOTIGeS AaOVE
�
r
SI6NATURg(S) DATE
{'
SWIMMING POOL PLAN FOR:
0
NAME JOHNSON RESIDENCE
STREET ' -K,," LA - 0 l;dQ» t't
•.IOB ADDRESS RANCHO LA QUINTA C,C. CITY LA QUINTA
,
PHONE OFFICE RES
LOT 43 TRACT P21 PAGE BOOK
_
MAP BOOK ,PAGE NO. a CITY
'
MAIL ADDRESS
CON5TRUCTION OFFICE PHONE NO,
SCALE
D TF
DRAWN BY
SOLD BY
CHECKED BY
O -Z
D.D.
PAT
l 7 REVISIONS DAT
2 P S► U CITY OF LA QUINTk7
DING & SAFETY DEP
GARAGE,� FOR COGS TRUCTION
� GUEST � GUEST - 4 +L � . ®ATS z
BEDRaOM _
. � SUITE - -'JEL:EC/T•I ONS
' CONSTRUCTION AUTHORIZATION STONE
g v V t;D
Rancho La Quinta
BATH SALES FIELD` TILE
3 DIG { BOtULI7ER5 (mfr -,•7 ""C`rt 4.i»-tOt.�L �. (�
DECK COLO �
0 PRE-GUNITE I'� rrr z
.` . UNDERGROUND L JANDY A
I r MASON"ARi PEBBJPLAS trig �.. • *-�
-
`
DECK S G TUBE
` GUEST
PRE -PEBBLE ? DRAINAGE NOT�Drainoge and irrigation for planters and pots, by
others, unless otherwise. noted.