9512-039 (RPL)LICENSED CONTRACTOR DECLARATION
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. 474127 A $!31/95
License # Lic. Class Exp. Date
Date 1 _ Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
() 1, 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 , SignatureofOwner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under perialty,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 STA.Tfi.i;:Llh(ii Policy No. 124267994
(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. C,
'Date: x. / J Applicant 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees. 1,
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's
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) 'v�. s , . '. ✓' . -••%/l Date i_ t k'r/ 1. .
r
ALC"
-BUILDING PERMIT
PERM ITIm 2_om)
DATE •r
VALUATION LOT
TRACT
JOB SITE ADDRESS 44-360 0coliflo Dr.
APN
OWNER
CONTRACTOR
S"1,"EVE DODSON GtONSTR.UCTION.
CENT MtY HOAXES COMMUNITIES
&8805A .PERI Z..RD. 9E9
1535 SOU114 D S"ii'fl.EET 000
Cf 1714EDR A:L CI1T CA 9234
SANT f3.ERN.A.R.DIN, CA 92408
(61.9)324-12_34 COLO1044
(909)381.0007
DESIGNEWENGINEER
USE OF PERMIt OUL.AN i IOR
FjOOL A:14f) SPA.
FEE DESCRIPTION
FEES
CONI'RACI' AMDiJ 't' 13.000,00 LS
TITUADW COST OF CONSTRUCTION
.113,000.00
PERMIT FEE SUMfllWW
PLAN CHECK.l?EE 101-000-439-318 $93,60
C0NS''19?,U(,-1`10'1N F)M- 101-000-41.8000 31400
NIECMNTCAL FEE -- POOL 101-000-421-000 $24.00
:E1�CT1UCAL .Fid -- POOL 101-000-420-000 545,00
1'1-UMBING 1- -- POOL 101-000-419.000 $27.00
SLUJB-T01TAj L CONTS'T,C'•IX110N .AND PLAN C14ECK
$333.60
LESS PU1 PUD FEES
$0.00
Q o TOTAI;, PERMIT FELS DUE NOW
$.333.60
C r
0;
,99
S
`DATE
RECEIPT,
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
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Paity Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPA
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond -770
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
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)
l SPA SPECS. GENERAL SPECIFICATIONS
s SIZE 71 DIA. 23P X 39S SIZE 15 X 28 AREA 334
- ' RAISED DEPTH -316" TO -5' TO -3'6
Y P.L. LITE 100 WATTS SHAPEBELA.PERI METER 77
TRI LEVEL SEATSYES TILE SIZE GROUP 3
22" 24" 27" TILE COLOR GMX 95
DAMWALL WIDTH 6"X BFT RAISE BEAM 8' OF +6" W/TILE
j SPILLWAY SIZE 12" X " COPING CANTILEVER 84'
POOL CAPACITY 11,250 .GALS
OPEN XX CLOSED PUMP CAPACITY 90 GPM
5, JETS.# 4 MOTOR HPSTA MAX 2 HP 1.5
r
P.L.81+ FILTER SYSTEM 3 300 SQ FT
2 spravheads in +6" .RBB FILTER RATE 100GPM
5 —tet 250 10'RTURNOVER 2.5 HRS
RETURN LINES. YES
— 3' 2 SPRAYHEADS
t % -r6'' STEPUPS MAIN DRAIN "'YES
SKIMMER MODEL DUAL PORT
7' SPA 716"R s
CHECK VALVENOT
1819+'. \r HEATER LAARS SIZE250 000 BTU
X
P.L. GASLINE BY S.D.C. 90'
-3 6 -3161 . I 20'+ / POOL LIGHT 40OW
'
SPA LIGHT 100W
7'6„R
CLOCK 24HR 220V
r 6'R i / ELECTRIC BY S.D.C. 184'
P.L. / ELECTRICAL BONDING BY: S.D.C.
g TILE AND COPING S.D.C.
2'R' 31 'DECKING BY S.D.C. 464SQFT
711011 3,
NAT/GRAY SALT FINISH
CONTRACTOR cannot assume
1
5'responsibility for damage to
W W oor W �, R curbs, sidewalks, -driveways,
PLANT /AREA cement slabs, sewers,
W S lawns,trees, fences, retaining
.. .. � .
walls, sprinklers, telephone lines
GM60'
or shrubs. When access is made
EM 62 W W through a noighbor'c property it is
nderstood that you, the owner,
_ - k ”
have that -neighbor's hbor's permission.ools a
S t and assume full responsibility.'
' 4 i ce
iif3C 3.
t D$'N-Ir] �-� _75;) Name
t1 t y Centur Homes
ACT E CONST ., Address�44360 OCOTILLO,DR.
SUBJECT TO I T aLLATi;� SFE nch
I c LA QUMA, C o. Ocotillo"
1 "Ra
POOL AREA TO BE UNCLOSED.B t
MINIMUM 5 FT. HIGH FENCE.
AND ALL APPLICABLE C DES : �
/%
ALL GATES TO BE SELF-CLOS.CNG. t
/ �� �. .C�. �d �a��� D SEER -A. 1�
DATE POO/T
AN TCHIN.