0204-157 (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
Date (r Signature of Contractor
v
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.
( : ) 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 - 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
Code, I shall forthwith comply with those provisions.
Date: �.f7 Applfcaht
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 applicator 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. r
Signature (Owner/Agent)
BUILDING PERMIT PERMIT
;'t1•i I t
DATE ry f VALUATION �:Y� LOT TRACT
JOB SITE } ; APN
ADDRESS 4. .i:�.:.-. •. 5.i ii •• - s,•, k A
OWNER I CONTRACTOR / DESIGNER / EN INEER
.x.�]�- 1�- f; 1 �''�•iat A1K�..+ti.11�r'.I
+ _' �ti►-ti�}'l.1 C'1'►
USE OF PERMIT
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I'Ail.iR•Yi,N .A I -Ki I N'P-V (`I0j' .M + d ('1
#'iN?141'A. A)3 ,Wdh Vf)AR€ tKf€9 SHALL lift I'N FT—ACH T MR, F]_;:
PISPf C1101:. M. 11f.J0gU" 'T4Ur 1?11111[3ClW
I W.L U.(* 1,:.
M,1MA:1rV10 (10611 fair (:IM 1IRM "r(ON f .4 ? '
1KNUFFFM SUMMARY
l".LAB 4 Ci uX.-fir%
i C13+1#"}'Rx ["1iCyti frill? 101.01* 438-(y[rIf #lS AP
M4.:LUAfIi'•A3.l. E •• TV"X 1., _ 1014 0J-421-NO $24A:l1
K.KA-,
'�} �1M1lii1,It3 ]'fi £? I'I Yi3I r } 0 I . tAPR
)i)0) � 19 2002ITYOFr AQUiWA
FINAINCEaEPT.
'i's7A,&I. "i .HMT#' Kk 111111& M IA N(Yw 1393.49,;
RECEIPT I DATE I BY I DATE FiWALF—D, _ I INSPECTOR
PC
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
AZ�
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Z
Fiiai
Underground Plbg. Test24,—
Gas Piping
—
PLUMBING APPROVALS
Gas Test
Electric Final
— —�
W&ste 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
— Q
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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5P:---V7'I(:,ATI0NS
rf'"T r SIZE
WR?lAce AREA OR POOL 14 q 9
90L-r-
5PA f-cEr-.Ir-'Ir-.ATION5 TILE
-'-4�! C.; 10 1
SIZE 50, "1 1 TILE rf?T
$*A CAM Y(ALL K --TW - yjArrq Lt%f
so. cc." TILE Tit 1f
L*47 1-2200 QUARTER ROUND
R.AlffP SPA AT d r
RPD. TLE
5011,LLAA.Y TY"
OFSe,IAL lid'. E3
50 FT
EXCAVATION 5TEEL
TYjOPX-,
j
ELEVATION -t �jCANTILEVER
vecx
LOVE SEAT C)EC40 MAIN
C40W
VMMOVAL 4, C4-1CORELOADS
500 RrICYAL LOADS
TOttw- RE14OVAL By STEM FACE
W-RiSATION REMOVAL Ere TILE BASE
FKR16ATION R-vwAIR SAJV AND VISOJM-S
61 kee, ft RIMONS
12, ".15. Mom STRIP
24' It2D
TAN SHMP
MASONRY K COPING TYPEtip
CENTERS
5P!LLr1A*f ryn
SIM
PLUMBING
FILTER ---1 SIZE PR -110, EXT. MAILS
POOL MIPA"da r I= PLAN" KOLL
OLFTAINN& MILLS
SIZE MPO. KALL5
ACV'. P.11 -r
0 vv -y. SI:' 1j 3 5
TINE aIX-K
AVOL 0JTL= t�X
FILL UNE FE55PLEA77
BMS UNE LI64T5 POOL
1.166-IT5 SPA
rcLwArN5,s-RAr,-A-" 44 *-^4AJ!v 500'r V -1 -AH
54F -PR ve OrWr SPA
ryv-,!SALL5 L-7
L16RTS 04 FOOL IN SPA
SIM SETFENCINS
WSC- c
ft"Ns SIZE
HWIT
BATE1--011�-
&JN! TIE SATE R--vT"'RA-
VMW DO RAMP AN6
EXTMEV 2md STEP
LCYT5eAT Lc)
61"I" WY, EST, START
CA?MLEVER
C45IPIN* 07 HER,
OVt`" TO, (1) PeT!"le THE APPROXIMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY OF EXCAVATION
(2) TA -KE NOTICE THAT FOOL AND EOUM%m,'Nr LOCATION* ARE SMXICT TO ACCEPTANCE OF LOCAL
LOCAL &ALVI" VE-ARTI4" AT TIN-' OF 15%AME 09 PERMIT
(3) VCT 170"4 LOW-XrTE 51CILL AT LEAST rKV! DAILY FOR SEVEN DAYS AFTER SHELL 15 IN5-ALLM
(4) A6qr! T14AT CALIFORNIA FOOLS 15 NOT FOR VN�-COt0T!OhM OR O%ZCT5,
AND ANY DAMAGE TO C-L"t-mk'3,VCw-Y(ALKS, VIRJVSWA'f5, LAY", OR 07r" MrIA5 24 THE ACCE!M AX?.�A
($) SM THAT ALL PEW -146, 64,TES, AND SAkW DOCKS W-- LO --AL OM" FOR A POOL ENCLOSURE
PRIOR TO PRE"TER MSPEOITION
(6) PILL M NOMMIAMY AP"M PLASTER. (POILLOH 1"TMXTtON5 - 00 NOT V-61-0 Ite"M HOSP,)
(1) TAKE MaW THAT THIS 0"11,16 M THE SOL? P�. TY OF CALIPOM41A POOLS NO THAT ANY
ME MTROVT WRITTEN PCRMt55'ON 00 CALIFORNIA POOLS, INC. 15 r"MTEV E" LAK
OVtVR APPROVES PLA" P01-olL, AM I!WPW4T LIXATION5 NO HAS READ THE "SPO IVLITIM AI* NOn%-M ADW
DATE
SNIMMIN5 FOOL PLAN FOR:
NAME
AUDE"
.RESIDEINTCE
STREET
JOB ADDRESS -ITY LO,
PHONE OFFICE RES
LOT e, TRACT PAGE BOOK
MAP BOOK PAGE NO. ICITY
MAIL ADDRESS
CONSTRUCTION OFFICE PHONE NO.
SCALE DATE J DPfWI OY SOLD By CHECKED BY
1/ 18 11 =1
REVISIONS DATE
A RE-INSPECTI, FE OF
2 1 A=INTA WILL BE (-,!�-'GED IF THE APPRO E
PLANS )
DEPT. i�,' JOB CA D ARE NOT 0
3- -DING&SAFEWD ]THE SIT- FOP A—SC-HE-DUI-E
—7
iVPPROVED
NS P E C' ; -0N.
4 FOR CONSTRUCTION
--+w+zu"IEPTA), S!
5
�LLLU i I ON IS
CONSTRUCTION AUTHORIZATION_ STONE
SALE'S FIELD TILE
DIG BOULDERS
DECK COLOR
PRT--.-GU,N E
UNDERGROUND JANDY
PEBB./PLA
IMASONARY
DECK SIGNATURE
Drainage and irrigation for planters and pots, by
PRE -PEBBLE DRAINAGE NOTE: others, unless otherwise noted.