0203-125 (RPL)LICENSED CONTRACTOR DECLARATION - 0.0
I hereby affirm under penalty of perjury that I am licensed under provisions of ;f
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 L=xp. Date
656129 33/�j C-8 141/31/2(
Date �� t` Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for thb4following 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.
�) IIhave and will maintain workers' compensation insurance, as required by
Secti6n 3700 of the Labor Code, for the performance of the work for which this
pelrmit is issued. My workers' compensation insurance carrier & policy no. are:.
Carrier Policy No.
S"E.'�i'E G{�.2>�fP£�`i�is��,i'1 09f1U9t1Uf}F6uaSi
(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' compensatio6,rprovisions of Secti n 3700 of the Labor
Code, I shall forthwith comply with those !Q Applicant—pr ions.
Date:
1,.
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:behdWthis application is made person at
whose request and for whose be efit 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 propertyTor inspe3ction purpo es.
�o
Signature (Owner/Agent) J A�` *` f Date
teVy,. 71.
w BUILDING PERMIT PERMIT#
DATE� VALUATION.LOT*'4 TRACT
JOB SITE .
APN
ADDRESS 7"W RAKCHO LA Qx91fi€u`rA DM=
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PO BOX 1716 •
147 25 JORC Da:%V4 RME 0A
%,R QC3IN TA CA 9.2253
PAi lfl:l MERT CA 92.260
USE OF PERMIT '
POOL. PA-MAC)h' 9'A
PWL AW) SPA# ALAAK-MS4.f[iARRPi'?,RS SHS. BV IN PiAME PRIOR TO
PRU€AITER MISPY0,17014, 7 LF 51 HW=WALL Cl:l Y S'1',i0NOARI)
P001JANDIE: R. SPA; y 291 0% Do Ls
5 PT. 'WP.LL 17.00 LF
PIAN CHECK FEE 101-000-439-319 $140,0
t7C3NSTRUC110N FSK 101-000418-.000 ��lfi.i3
m9CHANIM Ff, -- POOL 101.000-421.000 124.0
Fa,XCTfUCAJ, PUP, - POOL 101 -000-420-000 $45.0
t,U� 1131 =-POOLICi1a(1Q0.4"19^ate.. $7110,5
a MAR 12 'LUR
r9Ty OF LAQU1@�A
an,--fivrp.L CowmucmoxANI) fkx
S4}�1
��PT,y,0lq)�}[ ppppr�yp�
�.2.,..�ppE0
rim' FOUL DUE now
t 45.ZA a
RECEIPT
[!ATE r
BY , :�
DATE F LED
INSPECTOR
/,
n
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
;;
MECHANICAL APPROVALS
Set Backs
Underground Ducts
I I
Forms & Footings
Ducts
�[
Slab Grade
Return Air
I
Steel
Combustion Air
Roof Deck
Exhaust Fans
; I
O.K. to Wrap
F.A.U.
!I
Framing
Compressor
i
Insulation
Vents
I
Fireplace P.L.
Grills
i
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
[
Party Wall Firewall
l
Exterior Lath
l
Drywall - Int. Lath
I
-
Final
1I
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
.
Footings
Main Drain
Bond Beam
Approval to Cover
I f
Equipment Location
[
r
Underground Electric
{
Underground Pibg. Test
'Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
28 z
;
Waste Lines
Heater Final
! I
Water Piping
Plumbing Final
11
Plumbing Top Out
Equipment Enclosure
I(
Shower Pans
O.K. for Finish Plaster
g —y
Sewer Lateral
Pool Cover
] I
Sewer Connection
Encapsulation
I
Gas Piping
I
Gas Test
[
Appliances
i I
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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1
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Rancho La Quinta
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GREAT
KITCHEN ROOM
MASTER
10360 BEDROOM
600
IN/I CLOSET
KITCHEN
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AT Hf 5
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DINING I ° HER
MASTER ENTRY MA57ER
BATH DEN BATH
,• O
LIVING
TRY
GUEST
SUITE
GUEST
BEDROOM
0
MASTER
BEDROOM
PATIO
AREA
EXERCISE
ROOM
HALL
GARAGE
GUE5T
BEDROOM
i
HALL
e d0
� e L
NDRY
GUEST
BEDROOP
GARAGE
CONSTRUCTION AUTHORIZATION STONE 6,�o -•v.- '
DIG
PRE-GUNITE
UNDERGROUND
MASONARY
DECK
PRE -PEBBLE
SALES FIELD TILE N~„a U-1
BOULDERS,, �,-- t•T. W
Q
DECK COLO c,,, •
PEBBJPLAS,
51 GNATURE
Drainage and Irrigation for planters and pots, by
DRAtNAGE NOTEothers, unless otherwise noted.
9
�1ft/tt SPECIFICATIONS I
TYPE U SIZE x l J
SIRFACC AREA OP POOL _ __,_._ -.7
v �
PERIMETER b DEPTHS w - MAK
Q
U 1
cD
1(1
A' l0
Q
5PA �jSPEC IGATI ON5
Size S� __ x go PT
SPA DAM WALL i"MD7H - iS , _,._.,.
W. OF JETS
LIGHTO j
RAISED SPA AT y
SPILLMAY TYPE Ca"�
TILE
TILE TYPE
WATER LIHe
T112 TRIM
WARTERR ROI*ID
".B ,TILLr -
SPECIAL NOTES
v
J
d
U
DECKING �y
SmFT- P
PiNISH
EXPANSION JOINTS
GANTILzvm
DECK DRAINS 3 6 J TC-� PLI LAAAA-
EXCAVATION / TT'
ACfm PROM
ELEVATION �/
DEEP END RAMP V�
LOVE !CAT
CONCR!"ff REMOVAL LOADS
D9000 GRAIN -
WO GORE
t -
SOD REMOVAL �-"� LOADS
STEPS-
•
TREE REMdVAL BY
STEP FACE
f
IRRIOATION R&40V �
IRRI6ATION REPAIR
TLE BASE
SAND AND YI60LIEEN
,
W RBB "'�'
Rim
12' RBD.
18' RBD It
MCA STRIP
24' RDD -ft.
SO' RBB R
-�
TAN StIq.F t
�� �
.
MASONRY
Rx+c r
�••--=-
C1
COPINB TYPE ""...--
RBD PACM6
•"`���
SPILLWAY TYPE biZE Cp 7"
sT
PROP ExT. WALlS `���
PLANTER WALL
RETAINa4k4 WALLS
PLUMBING
FILTER S ZE
POOL PUMP 1 size Z• •
VOOSTM PUMP ° size
owl, WALLS �
ADDL PLUMP o.+ar'• SIZE
AWL PJM' 51=
NEATER "Zsj SIZE %:410<31 P''42
TIMe CLOCK +^�
90 PANEL S offal
ADM
SK"eft TYPO
PILL I"
PEBBLE/PLASE
_•__^'^
OAS Lite �r�- riJB5
a .ca
U&ITS POOL. 2: �R
L16HTS
POUNTArWSPRAYHEADS
ROLLED BOND BEAM
tHER
BLHMO SPA .....
Lwrr5 IN POOL.QZ;�"N SPA ` 'S a
EYEBALLS
ST''E SET ea m r-vr
FENCING
mw
M-"" SIZE
BATE
GUNITE
GATE REVERSAL
DEEP END RAMP
REMOVER RVA"
EXTEIVW"STEP ~
-
LOVE'3CAT
EST START
••
+SPR,LMIAY TYPE
CANTILEVER {
MY, H2f90NWPM
RBD -SEE STEEL
OWNER RE5PON51BILITIE5
OVMR M N DETtR*OE THE APPROXIMATE V.XVAT10N OF POOL OR SPA AT jj.YMJT ON DAY OF EXCAVATION
(2) TA kE NOTICE THAT POOL AND 52AP•SW LOCATIONI S ARE 9LeZCr TO ACCEP,'ANCE OF LOCAL
LOCAL CUILDIN& VEIARTMENT AT TIME O* 15WAW Z OF PERMIT
(S) MET DOM CONCRETE SIi9.L AT LEAST TWEE DAILY FOR WVn DAr'S AFTER SIM1 IS IWSTALLED
(4) AGREE THAT CALIPOWA POOLS iS WT R."'S°O"0L1! POR ROM&MM CONDITI" OR OE.PCTS,
AND ANY DAMAGE TO CURES, SOMAL" DRIVEWAYS, LAWNS OR OTM" ITV -15 M THE ACC1795 ARTA
(5) SEE THAT ALL MVNS, BATES, AND BARADE DOORS MtET.'T LOCAL CODES FOR A POOL eVA Mft
PRIOR TO PQV%.&6 M R MSPEGTION
O
(B) FILL POOL IMMEDIATELY AFTER PLASM MOLLM 1114STRUCTIONS » 00 MOT UW MJBM +090
(1) TAKE NOTICE TMAT TMS DRAAM 15" SOLE PROPERTY OF GAWPORMA POOLS AND THAT A:NY
USE WITHOUT MTTEN PERMSSION OF GALIFORMIA POOLS, W- 45 PROMISITED Vf LAW.
OWNER APPROVES PLAN, POOL, AND ew"4g !T LOCAroa AND HAS READ Tie RESPONSIBN.ITIES AND NOTICft MOVE
�
SI&NAATi1RE(S) DA1 E
SWIMMING POOL PLAN FOR:
NAME R.L.Q. DESIGN HOUSE LOT20 P21
57REET OV* A -Aron- t. O a 0 r .
JOB ADDRESS RANCHO LA QUINTA C.C. ICITY LA QUINTA
PHONE OFFICE RES
LOT 20 TRACT P21 PAGE BOOK
MAP BOOK PAGE NO. ICITY
MAIL ADDRE55
CON5TRUGTION OFFICE PHONE NO.
o
SCALE
D TEDRAWN
BY
SOLD BY
CHECKED BY
C1
D.D.
PAT
REQ' 15 1 ONS DATE
®•
F --q ,
2
5
BUILDING & SAFETY DEPT.
®
'
VE -D
�-
FOR CONSTRUCTION
W
0
DATE Y
5ELEC.,TIONS
H --
CONSTRUCTION AUTHORIZATION STONE 6,�o -•v.- '
DIG
PRE-GUNITE
UNDERGROUND
MASONARY
DECK
PRE -PEBBLE
SALES FIELD TILE N~„a U-1
BOULDERS,, �,-- t•T. W
Q
DECK COLO c,,, •
PEBBJPLAS,
51 GNATURE
Drainage and Irrigation for planters and pots, by
DRAtNAGE NOTEothers, unless otherwise noted.
9