0009-153 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 96(commencing with Section 7000) of Division 3 of the Business and
PrbfeSSionalS.Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7
Date Signature of Contractor
f
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).
as owner of the property, am exclusively contracting with licensed
' contractors to construct the project (Sec. 7044, Business & Professionals
O 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.
( 6);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 STAT.P, FU Policy No. 046-00-000"7934
(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 shal_I forthwith comply with0hose provisions.( _ _•-
Date: c-4 / Z �f'� Applicant's
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.
Yl
Signature (Owner/Agent) '��� 1. __.Date
BUILDING PERMIT PERMIT JJ
DATE i VALUATION LOT �`�`� TRACT
T j i.. c} 0 &.17 =00
JOB SITE
APN
ADDRESS 44-WJO CAT..IZE SAWABP"ARA.
OWNER
CONTRACTOR/DESIGNER/EN (NEER
WM GRO1+'PlH
MWE DODSON CONB°IRTWflON INC.
44-800 CAME SANTA tATM.KRA
73011 COUNTRY CLUB D& gUY['R F4
LA QUIDJUs CA 92253
PAI -0 IL DL.SLR`7" CA 92260
,
(160)346.4032 E^.RUt 1044
USE OF PERMIT
POOL ,a ND/l R SPA
POOL & SPA ONLY-.ALAR.MSIBARRIERS SHALL HE IN PLACE AT PRE
PLASTER INSPECTION, POOL EQUIPMENT ENCLOSURE IS ATOT TNCLUDED
IN THIS PERMIT
POOL AND/OR SPA 17,000.00 LS '
ESMATED COST OF CONB'1.% T10- ION
PLAN CHECK FEE 101-000-439-318 $117-40
CONSTRUCTION FEE 101-000-418-403 $.180.00
!! FCH"ICAL FT,E -- POOL 101-000-421.000 $24,00
LLECTK.ICAL FEE -- POOL 101-000-420-000 $45.00
PLUMBrNG FORE-- POOL 101-000-419.000 $27,00
b a ,
ffUB- OTAL CON9i'f€ 01711 -ION AND PLAN Cl &MC
$393.00
USS PRE PAID IM
$0,00
•A'olAL PLR 1 mss :IFUE NOW
$393100
9
RECEIPT
DATE •
BY n .
DATE FINALED
INSPECTOR
INSPECTION RECORD
v 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
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
_
Final
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
En!c'a�psu—lation
f
Gas Piping
Gas Test
Appliances
Final
ZA 2—
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:
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED SI I & SPIN SPA VERTICAL FINISH Ari�e�� mcz--- -. - -
PLANS AND JOB CARD ARE NOT ON t E_..__.a
DECK—•1 waB •-nii �. te@d.ppzhr c or d...d.. .AREA.- 33= P _"ljCR _ /t. --
THE SITE FOR A SCHEDULED i NTen`ame°"i h chaneiann 0��3xr — m
. _ ggpG(�Y.R is—ti�t Yar•.'t owner TILE CkDI(i_GROUP3 5Q 70 V
INSPECTION.. DECK na,re tl at � �-6. •am � , M
VEtMElt • RBB• SPAS=18' — I
NO EXCEPTIONS! COPING CAYTiLE�ER
DATE signature `0W1,!CAPAClT1! 9,800.G?L4_ N
: Gl4\TT P�IA1P_[APA(a7Y _ _ 103 m
— AIRPIPE 1ioTOR Hv_ STA, RITE._�P i.s m
ALTER`' STA�RFTE 300_ F'f - W
-P7L—'—
�-
FILTER RAIE
HEAIFILLAAn:.-WE _=5ci
RT 5•�^ _ 4.. LA QU T1'A. BOXES U�RNOV�R.=� _ _.'.. _ T
(�;.R, 'sr 'r _ _ ' R6'-3• NPDSIL LiC=OSSECC[O�' su"'ii�9;1�1'1�$_ — , _— 3
IrovsE SKIMMEBNQDEL AMERICA\ C
CHECKYALYE YES — O
- , KUD SRL C - .•
1' Rti'-T+ - ♦ - - GASLINE$Y- SDC FT.
-
216. . } _ :•.. - OD7LT0 `
2^ BELOW NCDSIIL Z
{' • _--- _ ELECTRICALBY .SDC
L ���LLLJJJ Ra A, 31 ft -- - O
l/l'-9^ ._ i[T6 .?I'•3 \ DECK@'L' _SDC WHISQ 753. N
DEGC_TYPE=SLT FTrSH COLDRI S
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��_` - ' SPA SPECS_• , t .
. - ';' .- 1_4-(.' - _'• �•:.r.: - f _ _ _ DESIGNERSI7Ei �— RAISEo a Ia• -
iLIGH[ SwFCCH .rrL D .E L(IE";To
IW -3' .. r - - RAN. Y IU LEVEL SEA Qo`22'..24 27•-
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y.'. • _L.. `- :21'6'' 24,3' .. - . VtSE - SPILWAY.SIZE" -3 "X'. t_ 'WIDE -
`. REVISED:-- LWAY*
' MASTDt- GfE . SIB-0Dti q Ei5 4 SNEER_ s., 7J .c
. rl3IDC. •'AhITA GRIFFTCH :.+• � -'1' W._.
FAMILY ROOM',
CALIF SA\TA.BARHARA.
ILII CI �N u., I9ACL RISA '`LLiTTg 7- PH 3 N
ADD ENT
RESIDENCE 0?L EATER SOUL
a .races• '•a '�•
ACCESS PALM DESERT,TEMEC&A
CITY O LA lsC n I 1 tl 6 R��j ^ !'V RIR BL.DCIC 73-011 COwny 28910 RANCHD
WALL CLUB DR. STE Fa CALIFORNIA RD. .
B0BCA j--_— _ 1/81=1' SCALE PALM DESERT CA. STE206
BUILDING &SAFETY DEPT. NO TE_LiNWCAPEANDnMM"JRE 92260 2590 ^� N
ARE'SHOWN FOR ILLIMRATION {Ism 3aC.ao�2 [90g167¢�yyly
ONLY AND ARE NOT INCLUDED:
Urr
FOR CONSTRUCTION
DATE 2cm c BY