0011-228 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I A' 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
614597 C53
Date4A 'n / Signature of Contractor --71-,---7_/
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 Sianature 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
Sebtion 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:
Cartier Z{IlND�3 Policy No:
)
(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
Cbd'e, I shall forthwith comply with those; provisions.
Applicant
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.
VSignature (Owner/Agent)` �� 7 %� Date A.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT r� -�"� TRACT
JOB SITE APN
ADDRESS
4.18 SALEM10 .
OWNER CONTRACTOR / DESIGNER / ENGINEER
JACK1:3C7iJFiQUDY 'BAN J(7J<41n7 PW. 4: w
43.6) S ssALERWO (7T. 6845 MGE Alf i:M
X..P. Qf3IN"1A CSA 5n253 'YUCCA VALLEY - CA 9,228A
(760)346.6355 CKS. 4796
USE OF PERMIT
POOL . AI YOR SPA .
NBt(ROLASS POOL AND SOPA o INCIPCOLYND DISTALLATIGN
(IC B0.0 . -3753)
POOL AND/OR SPA 47
J
r nNA7`D 0M OF C. OMMUMOH
PL A14 CHECK FER 10)-000.439.3 ) 8 3122M
CONS'i RUCTIO'hP iTZ I(1'k, Qf10 4 fwOfiU t 4.OQ
p7i,h"C7• ANICAL FEE -- :'COL 1 101.000.4'21-000 glh;tli2
F.;LECTRICAL FEE — POOL 90.7-006-42t -WO
Pl;tlMYNO FEE -- POOL 10) •0010.419-000 $A00
SPP.-'fl(`t'i'l E, CdMMUIMM.OM ANID PLAN CTl -;.X-
5401 >R
LESS FRE -PAD) FMI
$0.00
'I'O'i', L PENS I!'0:151 DXTE 140W
j
$407.4
RECEIPT S"•' ..
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
d
Final I
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
Enca ulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)
no (f4 -CITY OF LA QUI�Iy�A��YB-CONTRACTOR LIST
4/3 ler C
JOB ADDRESS y3 �� /,f PERMIT NUMBER p D l/_22� OWNER BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in'a conspicuous place. • Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a. stoppage of
work and/or the voidance
.of building permit. For each applicable trade, all information requested below must be completed
by applicant. "On File" is not an acceptable response.
Ttade>/;;Class�fication:.;;;.:::.:.:;;;;;;;;;;:.:;;::.;>;>Contrator:.:..:..:..:
•::..•:.:....::::.:::....::...::...:.::.State.:Conttactot..s::Lac..
:..:;.::
ense
_...........
.;:,.;.::.;;::::...::.::.
_::.>...:. . Workecs..Com
ensat�on..Insurance....:; ..... _
�n ss aacense
Crt Bus _ e
Company
Classification
License Number
Exp. Date
{
Carrier Name
Nmb r
PolicYu
Exp.. Date
License Number
Exp. P
DateCom
..� -
1xxxxxx1
- xx xx xxIT
1e. ..StateFund CalComP1
xx/xx/xx1
xxxx1
xx xx/x x
1(FormatVaries1
i✓EARTHWORK
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5TRUCT STEEL 404.1.................W.....
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MASONRY IC. _. 1:``` `:I::-x.-.:
=29 ::
tx
PLUMBING IC 36)
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LATH, PLASTER (C 3 1 ,
F
DgYWALL IC 9)
0
ELECTRICAL C. 10).;:::'.:>:'.:<
OF NG tC�3Pf<:;:':><::
SHEE`1'METAL.,IC.;;3,1.;.:.:;:::
Y
FLOORING fC 151
Z No
INSULAT.....N
SEWAGE
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"CERAMLC1 LE `C=5.4` ><»
;:::::::..:::::.::
UINDSCAPING (C:'27)'W'
271 ?
101
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-
71
-joct-01-99 09:101A ICBO EVAL SERVICE
r •
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`•TION •� ` ^,.. . - - ..... .... .. .. ... ,d ., r t_., .. - .�. �... „..-a -
-ICBGEvaIuati1.on' Service I'm
p ` • 5360. WORKMAN MILL ROAD • -' WHITTIER, CALIFORNIA 90601-2299' , 0 ; I
A -subsidiary corporation ofthe international Confe'renCecOf Building
562 695 4694
P_01
Officials
air
EVALUATION REPORT
' r' , i
w
Page 1 of 3
Y -ER
Copyright V 1999 ICBG Evaluation Service Inc '
r � 1 •. .
.r� r "�. » Y, • ReiSSt/ed August 1, 1999
Filing Category: SWIMMING POOLS AND SPAS (266)
;
HAWAHAN FIBERGLASS POOLS =+�+
r 1 • The existence of groundwater.wlthin the depth of the pool
HAWAl1AN,FIBERGLASS POOLS,,,!NC. a '
'17031 MUSKRAT AVENUE °
a .. excavabon.
2. Ttie existence of an uncompacted fill in contact with any
ADELANTO, CALIFORNIA 92301
portion of the poet
1.0 SUBJECT -
3. The exlstence;of ail i'e apsive or adobe -type soils at or .
Hawaiian Fiberglass Pools.
within th confines of the pool area. -`
' 'istence
q. The ex of any'still types whose angle of repose will
2.0 DESCRIPTION ' -
not supportthe walls of excavation at the desired slopes.
2.1 General:
5. Tlie location of the{poposed pool excavation is such as
to have a tendency to endanger adjacent structures,
The swimming pools ere of one-piece fib' lass construction
shop formed over a' mold..The materials are, mal and woven -
If any of the above conditions is encountered, the excava-
roving fiberglass, handjald over, a niciWand bonded with vinyl '.-
tion for the pool shall cease immediately urtta the specific con -
, ; ditions at the site have been reviewed and recommendations
ester as well as polyester resins. The exposed surface is faa-
tory coated with an 'lsophthalic gel a minimum of 30 mils in. _..,
`,', 'have teen made 6v a -qualified engirieer The engineers re -
-
port of this review: and recommendation is`to.be submitted to
thidkness: The completed pool hes a minimum'cured.ttiick ;` ;"
1
ness of la inch. The_aued fiberglass has an average tensile'''
--the building official having jurisdiction over the construction
strength of 18,000 psi and a modulus of rupture of 38,000 psi.
site, and his approval must Wobtairied prior to the continu-
ante of the work -The excavation of the pool consists or re.
For sizes and capacities of pools, see Table' 1. The pool shell
is structurally constrained by a continuous' bond
moving the existing soil from the proposed area with an over -
\concrete
beam and is supported by a'backfill of minimum 6 -inch layer
of compacted clean sand. The pool, has a fiberglass coping •
excavation of a minimum 6 inches on all sides_
- -- -i , - , ••
The require" ' f -ns and pumbing wrortc`are installed end a
all sides which is partially,., _,.'.
approximately r inches wide concrete
encased in poured-in�lace concrete slab:,F6' details,
contoured la er of clean sand is laced at the lower areas of
• ` •the pool up o a point at whidi "s of ughing` would occur. Ttie
-Pool
refer to Figure 1. The narrow end of the pool is provided with
is then placed°on this sand bed and carefully aligned'and
'orirregulerities
curved steps and a seat, A main ,drain is built Into the liber= '
glass pool at,the deep'end. A 2-toot-square'g►avel sump is; •'
leveled to -preclude any budding in the fiber-
, glass: Water is then introduced into the pod[up to a level ap-
provided beneath the main drain base to collect any ground-
r proximately, equal:to,the sand level.`°Baekfilling with sand is
•
water or drainage from the sand bed on which the pool is in-.
carefully continued upward;. rimaintaining: an approximately
uniform
stalled. A 1m/cinch-dlameterPVC pipe.is connected from�the, ,.
Height around the four sides of the.pool at all times.
sump to equipment pad and is capped.
The pool is sl rnu.ltaneouslyfitled with wateras the backfilling
_
All plumbing end electrical work must • comply with the-
r :
" progresses, maintaining approximately equal levels of water
'inthe'pool and -the backfill sand layer The backfill sand is
codes in effect at the coiistructlon^site. The pool design,re '
r
quires it to remain full of water at all times. A pertnanentJsign `
con- .
solidated by flooding with water:as the work progresses. The
is to be attached to the pumping equipment and is to read as
sand badkflll is stopped 6 inches below the bottom o1 the .cop -
;e onallsides of the pool. The outside lip of the fiberglass
follows: # _ ra . - -,
Notice: Pool, is designed to.remain full of water at
_g
pool coping is embedded In a concrete walkway (bond beam)
all ftes...The poolshell may be darnaged if water lev--
installed around the eniiiii pool., See Figure 1 for details. The
concrete, shali`.havei'a `minimum compressive strength o/
e) is allowed to drop below`the pool inlet:, Wlien apps? y
2,000 psi at 28 flays: w u
ciable drawdown Is noticed or if it becomes necessary;
to draitithe pool, contact Hawaiian Fiberglass Pools; .
' The pools are to be installed only by factory -trained and ap
Inc., or its agents for instructions: :
r• -
proved a9entsor franchised;lnstallers In accordance with the
-
requirements of this report. .
A pressure -sensitive label is installed adjacent to the above
2.3 Identification:
tlflcatton:z
sign by the manufacturing licensee displaying' his name,"ad=
.
dress andielephone number. - * -
Fiberglass one�i ce swimming,pools are identified by re.
2.2 Installation: �.
cessed lettering dlsplayfng the company name, serial number
The poets,rnay be installed without a soil investigation by a
.. anddateafmanufacture-- ,
qualified engineer, provided none of the following conditions
3.0 EVIDENCE SUBMITTED
is encountered at the site and subject to approval by the build-
•
report
An engineering report, pod plans, test data for the fiberglass
ing official: -
material and, a control manual have been submitted.
F. valuallon hTotRs of IC.BO Evaluation SerV/Ct, Inc., are Issued solely to provide Infaimation to Clam A ntwnbe6 of ICBo,-1 0zing the code ryin'n rvhieh Ura iepny
upon wXrwtenf it
it breed F. wrluation repwfs are not to be.. conttraed my representing aesthelfcs or any
dadon fur use ofthe subject reporL
other aiNbule,T not sprc J vairy addiessed riot at an endIa recomencn-
- .
T7►b "part is baled qon indg►endent te.Kv or ulher technical data.mbmitted by the
appllcunl. The /CBO L'valuatlon Jervfce, lne, technical J'a/f h- reviewed the
ltd /(Baits andlof other data, ba/ dots notp—rw tett facW ies to make an independent Verjrj(•adan, There it no waffanfy by. /CSO Evaluation Serv&v, (nc., r Wrexv
or impllr 1, - to any "Finding" or other matter in the reporl or as to rig, prodad cuvemd by the report ]Nis dleclaimer includes, bot is not Umited tn;
merehanlaAilitjt
w
Page 1 of 3
0c1t-01-99 09:10A ICBO EVAL SERVICE 562 695 4694 P_02
Page 2 of 3 ER -3753
4.0 FINDINGS the respective codes In effect at the construction
That the Hawaiian Fiberglass Pools are alternate meth- site.
ods of construction for swimming pools to these specl- 4.3 The pools are Installed by a factory4ralned and li-
fted In the 1997 Unit n" Building Code-, subject to the tensed Installer or an agent approved by Hawaiian
following conditions: Fiberglass Pools, Inc.
4.1 The construction and pool Installation comply with 4.4 Clearances from slopes must be as set forth in Sac,
this report and the manufacturer's Instructions. tion 1808.5.4 of the code.
4.2 Electrical and plumbing Installation comply with This report is subject to re-examination in two years.
TABLE 1—POOL MODEL, DIMENSIONS AND CAPACITY
. ......„. __....... ., . ....... 6...... - w a-.
M TH
LEMGTN
SHALLOW END
DEEP END
APPROXIMATE CAPACRY
MODEL
(hot, or f"WncMe)
(foot, or hei•4wnu)
(teat, or faetdnd�)
(foo6 or he44nci9e)
(polono)
Ttopi.�l
111
is
_ 4
4
2,900
'
Palin
1I
25
4
4
7,400
Mahan&
I 1
41
4
4
13,500
Roman
11
27
3
5
8,800
Neptune
_ 11
23
3-6
5-6
6.000
_ ^
Caribbean
11
20
3-8
5
4,100
Lake
11
20
4
4
3,950
Sand
11
18
3-9
4-6
4,1)50
Pond
11
16
_
4
4
2,IL00
Luau
12
28
4
6
9,500
Kcy West
12
22
-
4
4
4,115(1
Islander
12
24
3-6
5-6
7.800
(1talina 111
12
26
3
S
8,500
Maui
12
27
3-6
5-6
9,700
Aloha 11
12
28
3-6
5
11,3511
La Costa
12
21
4
4
5.000
Waikiki
13 _
29
- 3-6
5-6
10.500
Honolulu
13
33
3-6
6
14,000
Ncwpon
14
30
3-6
5-6
11.500
Newport 1
14
32
3-6
x
17,200
Qui
14
28
4
6
13,900
Newport 11
14
32
3-6
5-6
15,9(N)
Atlantic
14
32
—
3-6
6
13,500
(btal ina
14
32
3-6
8
17.300
Uttalina Il
14
32
3.6
6
15,000
Savona
14 _
32
3-6
6
12,000
Palos Vcrdcs
15
33
3-6
7
18.600
Aloha
15
34
3-6
6
15,900
Diamond Ilead
15
37
3
8-6
_
1Ii,000
King
16
34
3.6
8
17,000
Venice _
16
32
4
6-6
15,900
Capistrano
I6
34
_
3d+
7
16,51111
I .aguna
16
34
3-6
7
16,200
Dcl Mar
16
40
3-6
8
22,700
Raron
16
34
3-6
6-6
14,900
Kahuna
16
34
3-6
6-6
14,800
7' Spa
7-0
7-0
2-10
2-10
471)
Kchci
7-6
14-9
4
4
2.200
7'-6" Spa
7-6
7-6
2-8
3-6
495
I.a Jolla
8-0
36-0
4
4
5,500
8' Spa -
8-0
V 9-6
3-6
3.6
730
9' Spa
8-10
8-10
3-6
3-6
800
Oahu _
8-6
20
5
5
3,900
Miho
8-6
I I
3-(i
3-6
1,000
. ......„. __....... ., . ....... 6...... - w a-.
c+`
4%Oct-01-99 09:1OA ICBo.EVAL SERVICE 562 695 4694 .' P.03
a
Page 3 of 3 '
. ER-3753
�< < { ,
1. '•3(rMK;
I
IN ADOBE SOIL
MASTIC SEALdONT
Sit 641.4 x V0A WELDED
WIRE FABRIC
yr + SLOPE, Vi' PER FOOT' +
,+
r
s
Iv FTG+-
r ea
•i0 ',� oo eA ire
�, ,o'-. �
X
O , e� •
: �q����I t
PAPER OR SAND
SEPARNOA r
= A;�
�d � �n pp��
���� i �YI� ' (�I^ (� �U� 1
FORCIAY
�aODeE) WIL
"LY t
WREBAR `
k°
• 4'IMK)_COIAFy1CrEDORAVEI
FOR AADDOOBE 301LONLY
tY T COMPACTED BAND (TYP.)
Ste•
FREFIGIASS POOL SNELL
Fur Sk 1 inch = 25.4 mm, 1 foot= 31/4.8 mm.
DESIGN FOR STANDARD DECK (WALKWAYy--FIGURE 1
c+`