9910-172 (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
31%
Date / I l a 9nature of Contra to
OWNER -BUILDER DECLARATION
1 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 ispissued. My workers' compensation insurance carrier & policy no. 'are:
Carrier C '1,�i, Policy No. �31KTill 017) It
(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 Sectio 37,!60 tftfi?eLabor
Code, I sha I forthw th comply with those • rovi5ions,"' j r
Date: Applicanticm
r
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, indemnity
& 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 St2Ctbdaws relating to the building
construction, and hereby authorize representatives of this City�to en�� upon
the above-mentioned property for inspection purpsesr ✓
,,; • /: / (.--moi
Signature (Owner/Agent)
BUILDING PERMIT PERMIT�
JJ
DATE�f f VALUATION ��ii.QS�dB LOT TRACT
(78
JOB SITE 1616 ,15 ANIT A DMVE
APN 69044613-0*1
ADDRESS
OWNER
CONTRACTOR/ DESIGNER/ ENGINEER
6
i :i oi:1A� f. mV
..}.L IEA i;�ttr�'.N.°a)�•.`'
i87w s ,,xrm bit
2318. s, V01EYARD,AVENILFE, sUz° E .A.
LA ttilUIMT.A. CA 92 5 3 .
0Wlb.RK) CA 91.761
(909)947-6474 CB1.1t 5240
USE OF PERMIT
PO61. ANTX& SPA
POOL ONLY - A1:.Fi1iN€,ji!BHMER,S HALL BE W PLACE ATI PacT-i'T,ASTIR
POC -3L AhrD'OR a.PA. 13,000.00 LS
f"ST11.sl4:ra01.711 •.€5T OP CO Y1INV,1r.!T11 'jh
A�,ln��;1�+i
PLAN CHECK FEF 101-(.N.4439-318
Cc) FT I I1 a -fttn� dl ¢GGbO(1 �14� k.!�
Ha st , b'A.i3iCAL 5T[3, - - P001. 101-00011.-V2 1-000
t.a..f C" lU gal.: t IGE, -- POOL 1.01 E�(ls➢-4bt3�o �as.�u�
PJ,Llmn, k;u Fl"IE -- 1kX.)L 101-000-419i*0 s`a'r oo
py
R.ia•r• t_7TAI..CONK-i'Fc1 X" 1'ION AND P1..AN C;431i't: K.
$33360
LESS R.E-PNVOIFFES
$0.00
RECEIPT
DATE
BY{
4-
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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
l
Set Backs
Electric Bond
C f l
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
Encapsulation
( 7 - 26 -415
Gas Piping
Gas Test
Appliances
Final
(31-66-60
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:
WILL'BECHARGE61UNWROVIM
?W&ANO-jowD AM W, -off
THE, sftrl�tdk- ii -
LE6
Is
Pool Builders
Since -1954"
iBWE =.
V -y-
(009) 947-6474
(800) 479-5560
FaX (909)'947-4:193
X4131 fl� S. Vineyard Ave., Ste. A
Uc.'No.. el "92.r,53 - . Ontario,California 91761
MROPA
-AER
ES UK n�
I Am My op'i- ' ' � �,,
F KYW r
A0 �� Pni
LV PALMA nRz,. CM1NO
6A
7 4iql&
I 1 4
"SA
ORS il NIA CAMINO f
E s 40SADA
. CANTE10
Ir
LAND': 60-9 7.
A)UFI e
iWE
ION =:< <' RN RWIN
iCA Ea S 1I
'tIR R OCOTI LLO;',�
00 ict 50.W E OR
AXIDLA
co,
1NO'PVC GA S
PIPING Ab�i*lkb. jjSjjj& Wit ONLY
41
oumo wnuw FIVE
V. (5) FEET OF POOLS WATER*S
EDG4,TOPETEMPEREDGtXS&
BARRIER REQUIREMENTS PEEL 1997 UBC:
FENCE TO C1
%�Y TO:
X
ML9
DEWMIJNq;EPLVETAS PAkT,,OF THE
'.WHERE WALL OFA
"AR . RM REQtMtM-ANY DOORS-WTTH DIRECT ACCESSTO.,
THE POOLSHALLBE EQUIPPED WITH ALA�:DLE ALARM__.
tHALL-SOUNIDCONTINUOYSLYFOILA
MINIMUNOF30 SECONDS,'
WlTtgN7-,SECbNDSAFrERTHEDOOR,IS"--
OPENFD'(AND SC
IF PRESENT )"AND BE CAPABLE OF PROVLD1N6kSOUND PRESSURE.
LEVEL'
0 OF NOTLESS THAN 85 dBA WHEN MEASURED INDOORS
ATTEN(10)FELT:
7k .-W
V
GATES MUST -BE SELF-CLOSING.
SELF LATC11INGAND MUSTOPEN
AWAY FROM THE POOL,INCLUDING GARAGE SIDEDOORS.
=NO DOUBLE LEAFGATES P - -8
% EILMITTED.
POOL EQUIPMENT SHALL BE A MINI-NIUM OF FIVE (S.) FEET
4 FROM PROPERTY LINE.
POOL HEATER SHALL BE
A'&MrIMUM'OF FOti (4) FEET FROM
OPENABLEWINDOWS t'Sh
rE
Poo
MI
1.
fqCtEss do ct 72e
oi►-U 0- focatiou and distance
RECEPTACLES ON THE PROPERTY SHALL BE LOCATED AT LEAST
• TEN (l0) FEET FROM THE INSIDE OF THE POOLOR SPA ORFOUNTAIN.
ALL RECEPTACLES LOCATED WITHIN TWENTY (20) FEET OF TIM:
INSIDE WALLS 0 F . A POOL OR FOUNTAIN SHALL BE GTI PROTECTED.
EXISTING LIGHTING FIXTURES AND LIGHTING OUTLETS LOCATED
LESSTHAN FIVE FEET MEASURED HORIZONTALLY FROM THE INSIDE OF A
POOL SHALL BEAT LEAST ftw (5) FEET ABOVE THE SURFACE OF THE
MiX1,N1WM WATER LEVEL AND SHALL BE RmGtDLY ATTACHED To
THE EXISTING STRUCTURE AND SHALL BE GFI PROTECTED.
ANY PORTION OF A POOL LOCATED CLOSER THAN SEVEN (7) FEET FROM THE
TOP OF AN ADJACENT DESCENDING SLOPE SHAL L BE DESIGNED AS A FREE-
STANDING UNIT NOT DREAMING ANY LATERAL SUPPORT FROM THE
ADJACENT SOILS.
UCN=MAL IIUM: (Temp.#
MAXIMUM WIDTH: ' IF)' PERIMETER: AREA:
MAXIMUM LENGTH:, POOL CAPACITY:
'060L DEPTHS: !/ 17 TURNOVER WE:
EXCAVATION QECKIN,9D
Access Rear Type re
Bob Cat Shuttle Dig C !or
Perrove'Dirt Risers
Remove Stump(s):," Footings
Remove Fence VO.-% Mastic vf,<F�
Replice Fence VPS Drain7s. 1-13 tit r.-eLD
Remove Concrete S.F.
Sawcut Concrete Ft.
EOUIP
FR4'rTy MeTIC+Size- jq()
STEEL
Turn p HP" 2: 2 So Q Sp.
r
Expansive Soil Steel Patterri BH B.H:C.C?Yes -QNoy,.
PLUMBING••P/P+/Orp (Oione) No
. SrrartUqht . Yes 4q6'•
iFilter- , Run Ftg:
Return .lun,es
-.
P-Tralp EVWash U64 Sm -- 500 - W V
Li-ght No
das Ur�fe, Ftg - art ac 11. x- 7n No
- - 777--7 Heater -BTU � 00 Pro
'Drili..Dnve'.
Div #Boards-
,
ELECTRICAL
-'RLih By, ftg, Water Feature:
GUNITE
PLAST1%.
Lo�-ei Seat A10
Out ,swim 6t Color'
lNt.2nd Step
R.B.B. in. X -'FtSPA-
:
R. B. B. in.,X, e- In Out
Ft.i-
7-7—x g
Plu •-Run
7-
a
COPIN tam w ngtWH!�
r
Ttkumbero
ype.
:,Blower,.
H 0P,' No
ISTICi Rdm M qI 4,
Z7 .-Sp witch; No
4. A
S Y Nc
Spa Dim . � ki�l
77
BUYER,4
'Initials
• Approve atiove Sp66ficafibris..
Approve equipmentlocatiiq�oh-471
equipment
•
derstanclthat decking shown is for illustration .pVrposes'only and
understand that they are to receiv'e _qQ 0 square-feet,of deck.
Date,
Prepared -Especially For:
Te..nKx
Street
city -L.4 GO( Kmf� Zip
Home Phone T7 2- 7Work Phone
Ilk.
Designer
Job No.
Lot
o-Lot !.lock Tract
Mapsco No.