0010-159 (RPL)LICENSED CONTRACTOR DECLARATION
I '-ereby affirm under penalty of perjury that I am licensed under provisions of
«.Ghapter 9 (commencing with Section 7000) of Division 3 of the Business and
P70116ssionals Code, and my License is in full force and effect.
License # _ Lic. Class Exp. Date
31141 2 C5 141)1 -
Date'• !: S �` } Signature of Contractor
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 ) 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.
S d 79Illi° ZJ#401
(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
Date: Applicant—
Warning:
pplicant 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 requestnand 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.
Signature (Owner/Agent) `"'� I i. _• ` '• YY f Date
BUILDING PERMIT PERMIT # '
DATE VALUATION LOT 0010-159 TRACT
JOB SITE
APN
ADDRESS
44-875 SANTA ]RARDARA
OWNER
CONTRACTOR/DESIGNER/EN (NEER
.tea L IiRAMURY
l+S i7%'£, CE3ATMUC UN,
:L,& qum. -,A CA 92253
PAT -M. DT? Irr
(s �773-3293 t'Y3J:O 5302
USE OF PERMIT
P00L.fel'f:►JOR HRA
PODWSPA ONLY, .13I ARN1:sAW.h',5&P3 SHALL 0.9 IN ,PLACY, AT
PUZ.-PLASTIM. WYl''3401011. P00b EQUIPMENT BNMOSU' t1 13 NOT
POOL AND/1DR DP.A If1 Op.It&0 'lam
.Lf6YbII,R�fidt9Ed:�D S.+4✓5 OFwMOdYA7d.IIAnG C Ri.�.7d�
'.q�
1011'�iisYfs00
Yips p1u Pt
:'£;AN CRACK MA, 101-000-439-318 "6105
CONSTRUCTION ME A 01 000-418-000 $117.00
I:fkA AXICAL VFE -- F'c.3OL 101 -WO -421.000 S24,00
V,i C. PJC,A1 ."1,Z— POOL 101.000-420-000
PI LUMi?F00ITY.--POOL tai -000.419 -eco ST9.00
t,,.
MB -4r {,1.rAL CtL%dT1",��Tt�'.10N A3d1.:A MAN CREC .,
: 299.E05 •'
5.1.E .E`XZ P� :S
AD
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OCT 18 20off'.M u, S;wm . Fus Dum; Now
_
t L
RECEIPT
DATE
BV t
DATE'FINALED
INSPECTOR
INSPECTION RECORD
4 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
r
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. 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
Final
Gas Piping
CC4
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
Gas Piping
Encapsulation
Gas Test
Appliances
Final
r
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)
op nslbili
etc
s, retain
or -sheik
at you, the owner,
sion as assume fl
GENERAL SPECIFICATIONS
t SIZE J ^
AREA PERIMETER
'DEPTH 3'(n'- - S- 6 ....
TILE CHOICE SQ. �frl
RBB. PO
COPING
- -.. - -
- .
�Y13;mp �� POOL CAPACITY pa GALS
_.
� PUMP CAPACITYGPM
- - -... - - - -- - - L'----- MOTOR HP Lk�yA)#~4
/ 20 HP / /y
MOTOR HP HP
FILTER ga.,q4".
SQ FT
o
FI o GPM
_
XI i" -- - -
HEATER �,C&6IZE qo0 -v o BTU
- - . �% %•� - _ TURNOVER HRS
.�� ., S� SUCTION LINES
3 6
RETURN, LINES
- --- i -
SKIMMER MODEL �Tl•.
:-------- ---.--- - -- - -- - - _ _ .. CHECK:VALVE yeS
- GASLINE BY 60A*kG FT. .ZO
.POOL LIGHTe-S CLOCK YCS. _...
-- - - - - - -- _ - - - - - - -- - - ---- BY %,
-=-----------,� ._.. _..� _. _ .._. ... _ _ . _ - - ------ - - - -- --- -- - •- ---... _ ....._ _.. _ _ S . _ .... _ .... - __ ._ . - - - -- - - - --- - - -- . - --- - - ----r---- ----;- --?-- -_ -- - - ._ _ .. .. ELECTRICAL _T ,�
AUTO CLEANER
a
HEM: FEEDER rd 0
------ ----- — --. —rte i
PLASTER COLOR
-- - - -- --- ---- - - --- -.--- ---- - . - -A
_ DECK TYP
STEP FT.
------------ --
—.._._. _._ ......_. _.- _-.. ....... - loo
Y . LI
�TRI LEVEL SEATS.
DAMWALL X- FT:.1
DESIGNER DAMWALL TOP
SPILLWAYSIZE —X' —'WIDE.
— DATE SPILLWAY PEN CLOSED
# JETS"UPPER . , :_. LOWER
----- --
— --
_
�r
GA.
ame: -
A/
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�BE.CHARDTION_FEE
Address: C/ tF87,s
PANS -AD
ED IF THE APPROVED t Qom
- - - - -- ---D ARD -ARE -NO
- TETE- SIDE TON
_ FOR A
CTION
SCHEDULED
-- -- - -
:
- -- -- -- -- - - - ---
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� � ExCEpljplVS�
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-• . _• -.._._._. _
f.
IFOR C
POOLS • SPAS • LANDSCAPE
DATE � / BY � i �--
- 74360 velordo Drive 760 773-3293
4.- - atm Desert. CA 92260
�— tote Lic # 331412 Fax (760) 773-3293
s
_ ... .
- - - C CTOR cannot assume res onsibil' or„ GENERAL SPECIFICATIONS
da6ze to -curbs sidewalks- driveways, cement �
:_ -. .. _SIZE
-
_ sewers lawns trees fences, retaining
IZE
PERIMETER
-��- sannklers telephone Gnes or shrubs._ A
n - 3.�
f Z, V'� access is made through a neighbor's -
_._
_.... -
-_-- -pronely it is understood-thatyou the owner TILE E
t -he — -n -
-_ tha _ ---- - - -
i bor's e� Sion an assume full ABB. Q
res''" nsibili - COPINGCOPING Ccs .-tr ILUt�t
POOL CAPACITY
J a o0 GALS
ole PUMP CAPACITY p GPM
IS
I-
-
MOTOR=
FILTER RAE GPM
HEATER „/SIZE d/o0 o0 o BTU
TURNOVER HRS
SUCTION LINES Z"
- 3 �� S� 6 - GJ �. RETURN LINES 1 "12,
_ 1
SKIMMFR'monFI d &4A*&-
..- _-._-.._...__ _ ..... _ ... - _. __.._.__• - _ ._ i .- _ ;..,,.�•.- .fes. -� `:-_:-__- ��� : GASUNE BY Cpar`Ilq,!' FT. .Zt�
POOL LIGHT.es CLOCK �5,
---- - .. _ _ --�- -- - ELECTRICAL BY. ,r' Lk T o .
AUTO CLEANER AfLNG. .. . •���_;
LEDER rJ..CHEM. F
o
PLASTER COLOR .
- -- -- -._:.. _._. _ ... __.. __..._...- --- --_ -- - - -- ... . -.._ Qt -_.- _ —. � — --•- _ DECK.BY SO. L
CO
. � f
TEP FT
i
SIZE.1.144 PAISED -f Z
UTE\/e5. WATTS loo
+ - -TRI LEVEL SEATS
_... _ ... DAMWALL X FT.
DESIGNER DAMWAU_ TOP
--- ---- = - --- --- -r- --- ... _ _ ._... --- - - -- -- SPILLWAY SIZE --`X - 'WIDE.
_ -
- - -- --
--------•---- -- :. � - ;-- - - - -. -- - - .-: : - : f _. . -_- ------ •----- ------ --'--_-- --.-
_ OPEN =SPILLWAY -CLOSED
# JETS -
UPPER ..._: LOWER
Name:.
••tom b�-.
- UA -1
Address: -
_._.___. L4-\
- - POOLS •SPAS •LANDSCAPE
74360 Velordo Drive Wk. (760) 773-3293
- - Palm Desert, CA 92260
State Lic.k 331412 Fax (760) 773-3293