9601-106 (RPL)LICENSED CONTRACTOR DEFLARATION
I hereby affirm 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.
i
License # Li60 , ass) C . Date 212&V7
YDatet� Lr SignatureofContractor j
OWNER -BUILDER DECLARATION
I hereby affirm 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, 8USIFIGS8 6 Professlunals C Aa).
( ) 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 sectiiin;H cIrti"&be completed if the permit valuatiotl= 066$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.
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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 author a repro entstives of this City to enter upon the
above-mentioned property for ffig�ectiorpurposes.
Signature (Owner/Agent) le. Data (f,
ALCM
BUILDING PERMIT
PERMITi
AAi:A1+1 ws.
DATE
VALUATION LOT
TRACT
rah
JOB SITE ADDRESS
APN
v •w' '�
414270 h f
OWNER CONTRACTOR
SUVRiSF POOLS
RICHARD PRA DO 440*23 ELKHOR:N TR.
SAME PALM DESERT CA 922M
r •4 CA A
DESIGNER/ENGINEER
340-5521
USE OF PERMIT
KY0.1 ,VN D,'0 "I"i"i
PO(JIL AND SPA
FEE DESCRIPTION
FEES
POOL Al IXOR SPA 12,000.00 LS
ESTxi�r"..r�IIE D C0.5,4 or, CONSTIRWIVTION
�2,0i(411.t1iF
i'ERM11' VII C' SUMMARY
PLAN CHICK F'F:is 101-000-439-318 $ii x.75
C ONST'RUCTiON FEE 101-000-418-000 S
N1GC'1-iANtCAL Fr~i"s -- POOL 101-000-421-000
FLFM RICAL r -UP.. -1001. 101-0001-420-000 S45.00
PL UMB1140 F'EsE « P001. 101-000-419-000
SUB -IMA L CONSTRU MON AND PLAN CHECK
$319.75
LESS P12. -PAID FEES
$0.00
TOTAL PERIM111' F.EKS DUE NOW
$318.7.45
RECEIPT /'
DATE
BY
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
POOLS - SPAS
steel
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
Encapsulation
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:
+
-
ot t SPICNCATHMS
POOL SIZE
POOL AREA 3CI0 _QlQ. FT.
-POOL PERIMETER -10 LINEAR FT.
DEPTH 3'6' TO 6`
COPING 6.41\171. -EVER
Tl[:J5 CHOICE 6POLf 11
POOL CAPACITY fif. 10,000 GALS..
C
PUMP CAPACITY
qO GPM
POOL PUMP 151 tX-TKA I`L,0. HIP
FILTER QUANTUM 175 SOFT.
FILTER RATE 175 GPM
Aff'KOX. 4 HRS
TURNOVER
VAC/SKIMMER 11/2 IN.
RETURN LNE I IN.
MAIN DRAIN ANTI VORTEX
MMIMER MODEL DUAL ..f'0KT
FILL DEVICE VlAl\i)AL_
HEATER TEI-E--DYNE 1250,0001 BTU
-NKI'ff LNIGTH i
GASILINE 3Y: 1* ' 0 PT. E. 0
LIGHTS -POOL '400 \/T. 'SPA 100 WT.
JIME CLOCK NN.4TIC TE;"l 4 HK.
ELECTRIC BY: tAJI\JKhE -BOWDING ;tJI\Ill\f`_nlP
POOL CLEANER' N/A
CHLORINATOR N/A
DIVING BOARD N/A
LADDER N/A
SLIDE N/A
ROPE RINGS N/
ACCESS TRACTOR E5015GAT
GRADING NCNf-= STUB PLLIMB- NO
DECKING 5LJNKI5E SO. FT. q50
CONCRETE REMOVAL BY: NONE
RAISED BEAM=LENGTH N/A HEIGHT
KALE 8' DRAWING
K6AKDO PKADO,
1 -OT 62 �y-�� o �� /lo . ��
FANCH0. 0GOTILA-0
`LA QLANTA, GA 82253
(619), 34005521.
SUNRISE' POOLS PALM DESERT CA.-.
CALIFORNIA UCENSE.NO. C53-556236
APPROVED BY:
THS 'DRAWING REMAINS'THE 'PROPERTY OF SUNRISE POOLS.,'
REPRODUCTION -:'OR- UNAUTHORIZED. USE WITHOUT WRITTEN
PBRMSION IS PROHBITED.