0105-023 (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 # I Lic. Class Exp. Date
Date
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
Section 3700..of the Labor Code, for the performance of the work for which this
permiv is issued! My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
STATE FUND 1526331-98
(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 -those provisions.,,.1'"" r"!'
Date: ✓ZZ19 ADDlicant
\ti _ Warning: Failur_e_:to.•secure Workers' Compensation coverage is unlawful a [at shall subject an employer to criminal penalties and civil fines up to $100,000
addition to the cost of compensation, damages as provided for in Section 3
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Saf
for a permit subject to the conditions and restrictions set forth on
application.
1. Each person upon whose behalf this application is made & each persowhose request and for whose benefit work is performed under or pursuan
1 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 urposes.._•.
Signature (Owner/Agent' '" / - +e�• Date r'/�✓n
' -BUILDING PERMIT PERMIT#
` �>cai ai7.�, 7
DATE VALUATION ,`LOT - ,TRACT y
JOB SITE «
AP N
,ADDRESS
44•61€9 CALU SANTA BARB :
'
_ a
OWNER
CONTRACTOR / DESIGNER / EN INFER t '
Ro Y' C?iA7WS
DODSON PC*1; 8 y •... k , .
44=610 CVNIM. 0AMA B..ARBAR .tA.
,
73-011 CU TAIRY %LUB DRM ON
LEL Q1,T.U..TrA CA. 9125:3
:b,>.�`A i7I&a�S° 1 RT CA. 9,7260'
(76G)346-40:32 C,'ajup 185s,' ' :
USE OF PERMIT
POOL, A SPA C(NI P - ALARMBA3".p. ERS ali3.f'iLL Oft rrt Pa.Acs A7•
PRA-PEASTRR INSPECTION.
POOL AND/O SPA 1k'3
X�'F.14U'X' M C:041yr Ole COM11. TC:'1110PT
1±3,ts�3d�,fD>'1
PLAX CHECK "IF, 101 -000-439-3 3 8 CUBIT
CONSTRUCTION FRE 101,-000.418-000 $i9s.fH+
PJ1E.t.",iE)AN1C.AL TBE • POOL 101-000-421-000 SX00
' P'L.`V-T IC R L ME POOL, 101-.00"20-000
JPi,t3Fa3BING F911• - Pool, 101-000-4103-000 WIN
MAY — 2 2001
•, t
CITY OF LA OUINTA
FINANCE D5AT'!B-1`CYfJU, C A rRUCTy.ON AIS PUN CTW
34dXAI,,,.d-G:.RLvir YEWS TIFV'
•y lU'S'.b..G,• Obi �,.t.� ••;.+
RECEIPT
DATE /' /
��
BY
DATE FINALED
INSPECTOR r ,•
{ s
_•-tit
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs I
Underground Ducts
Forms & Footings i
Ducts .
Slab Grade 1
Return Air
Steel }
Combustion Air
Roof Deck 1
Exhaust Fans
O.K. to Wrap I
F.A.U.
Framing I
Compressor
Insulation l
Vents
Fireplace P.L. I
Grills
Fireplace T.O. {
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall 1
Exterior Lath 1
Drywall - Int. Lath I
I
{
Final
Final t
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs I
Electric Bond
Footings I
Main Drain
Bond Beam I
Approval to Cover
}
1
Equipment Location
Underground Electric
_
I
Underground Plbg. Test��
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines I
Heater Final
Water Piping {
Plumbing Final
Plumbing Top Out I
Equipment Enclosure
Shower Pans I
O.K. for Finish Plaster
Sewer Lateral I
Pool Cover
Sewer Connection I
Encapsulation
Gas Piping )
P0_=6— at -D
Gas Test J
Appliances I
4
Final
1
I
COMMENTS:
Final I
Utility Notice (Gas) I
ELECTRICAL APPROVALS
11
Temp. Power Pole I
U
Underground Conduit
Rough Wiring i
\,
Low Voltage Wiring
Fixtures ]
Maht Service I
Suti Panels }
Exterior Receptacles '
Smoke Detectors I
Temp. Use of Power
1
I
Final i
Utility Notice (Perm)
rawsu-� -rxFa i•�•— ••�•,:•, — SIZE 9 X 36 '
1 Arn El DES M & Ft FVA7XW AREA 315 PERNETER 90
BOUSE BY OWNFR [Yt OW R'G Af.FlR- OE>'iii 3' X S
D
1F ].NDSB-L ( Natc! Fa Tilc Spillway - TILE CHOICE N1E 43 -5Q A
DATE RBB. SPA AT + 6'
DECH ' An Ape Gldlpi^vf lfgnan COP.YG - CAN-nLE\-ER
I-RLWW MID61LL Double Cmulln-er Cap am tial o5ek _ PCX)L CAPACETY 16,000 - GAl$', N
Suip I. Fo3 Fin6h rile)- Y07E 1 PUMP CAPACr1' . 102 GPM 1
Sary Tnm (2 rw•s) S3roTrim!'_nnss) — DUNEEPALJ.1ROAD STFPTFJ\I PUMP.Ali d :STA RITE - HP 1S m
__.._ 36-0
ovJ n y FUER' - STA R17E 300SQ FT m
FILTER '
.. ... ....P/L.. A.... ... ....� r0✓� HEATER Sprite
. - SIZE a00' •BTU N
NG BLOCK WALL-
rtJRNOVER4 HRS . N
f - la'tY .1 ..6' _ SUCMN LINES 2Tl
RETURN LINES .: 2 3
SKIMMER MODEL A.ME R[CAN .
GAS STUB ONLY 7•-D' r ... - - _ q�. CHECK VALVE' ' YES.-- ." ly
r' C>4SU2E-SY - 'SDC FT: 50' � O
POCCLIGHT 400W., CLOCK T141 C
12 {F ELECTRICAL BY. `SDC FF: 25ri p
Y
• \ Z
-11'-4" \ Ir-0LOR " PLASTERCOWmE 0 .
11'-_" O
DECK BY '.SDC 5 -T-O O
P!L Y DECK TYPE--' S- -ALT - SANDSTONE N
�� RETID'.'ElIOOPF c - ,(7FL. - •' J _.
DFstG�ix SPA SPECS
_.GRFAT, RaOAy 512E. T m +6
:ROOM • - .+ LFrE` 190)-40,
S )
. ErLw DATE:Z IN LEVEL SEATS 227,24 27' -
-: DA11WALL .. 6'IX 7 FT'.
' RESIDENCE ai13<o�, OAMWALLTOP..Tde worcxavcrc
CITY OF LA 4 U.INTA
�Ez--.: REVISED SPILLWAY St2E T
Y. D E PT.
& .5� -0" — c S-D- SPILWAY XR OPEN : Cl:OSED
t" rt3ET5 . °UPPER-..•.IAWER
SAFE
,BUILDING -7-ROY'OWENS;ri.rly
1 8 si 44610 CALLE-SANTA 0
�j- BARBARA m
NSTRUC:. ;ION W
FOR CO Yz LA+QIA ATq A
$TER CO soNivsa,
gY! MA h et v..
DATE s O r DOI�SI
O�(
a 3 .. s . r .v Fiw ,�..,'V - '� � _ .. h ... ., i�s .... .- .. .±•.w:.�..F.yyL OO�V f.
h
B°bcstAccas PALM DESERT TEMECULA
R&R 81«k:Wall M/ 1/8'=1' SCAIE 73-011 CDLNiV CLta OF- _Za910 VAN010
SMEF-. CkNOOM AD. SM Zai399
PMJa OrlF 72, C4. 9226D TEWCU. CA 9_
(760) 3.4.032 1. (909)67479.6 T
UC C A-
C53-.KC-574127
0
\ W
J '
Mar 14 02-02:56p- Dodson Pools 760 341 0895 p..2
QUINTA
BUILDING & DEPARTMENT
p01R - 12
MA`( SPECTI, NR UEST LINE
-71 3
Contr cf
PermlfNumber 0.105-023';:
POST OR JOQ 1WCONSPIC00US PLACE
INSPEGTORMUST,SIGN.AIL APPLICABLE SPACES
JOB ADDRESS 44=60'CAT U SANTA
BARBARA ,
POOL &>SPA: ONLY -ALARMS/F3ARRIPi2S SHALL
BirIN�PLACE AT;PRE PLASTER fNSPECI'ION.
TYPE;Of INSPECTION i DATE INSP.
FOUNDATION ✓ISETBACK' g
FOOTING STEEL*
MA4a;GROUNVSY.STEM 4
GROUND'PLUMBI NG:,,,-:
PRE=GUNITU
eDO_NOT PO -VP CONCRETE'UNT►L-*ALL ABOVE HAS BEEN SIGNED
CpN,ORETE-SLAB »
:JOISTSA GIRDERS
ELECTRICAL GROUND WORK
DO -NOT-.66URAICONCRETra UNTIL ALL ASOV Hq ":BEEN SI
ROUGH.ELECTRIC; '
ROUGH PLUMBING° �` :� _ •
ROUGH.GAS r _GAS TE5T F
HEATING VENT -IVC
'FIREPLACE
ROOF::
,BOND BEAM,
O:K'.'70;.WRAP
GROUT Q'4* 0.81
i-
FRAMING
• INSUL'ATION .R
PHL-RQQF.
r``..COVER.NO:WOAK UNTIL',A9OVE HAS BEEN SIGNED
DRYWALL -INTERIOR
E ETERIOR„LATH
POOL PREP-,LASTER,;
PCNL FENCE 8 GATE -. vL
SEWER SEPTIC.TANK
FINALS '
.. ELECTRICAL,'
PLUMBING s
�;FINAL,OR3 TEST.
HEATING A1P .
"HOUSE NUMBERS j
40B COMPLETED
`TEMPPpVNER
:i4LL�iCONCRETE FLAT.' -WORK SHALL'.Bi`PLACED A
--*Ni' bm OF ZZ BELOW ,WEEP SCREEDS. `r
Wnf-. j . ., ,.