9610-010 (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
574127 Aill �}i47
Date& '7• Signature of Contractor t,t i
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 excluslvely 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
Sdcfion 3700 of the Labor Code, for the performance of the work for which this
permit is is'suetliMywuorkers' compensation insurance cdrrier'.t&tpojicy no. are:
Carrier Policy No.
(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•
,/bate: A R Applicant '
x
Warning: Failure to secure Workers' Compensa Ion 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 hot 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
y 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 or inspection purposes.
VS nature (Owner/Da
Agent) • " �" • te _ 7=�
PERMIT# . CONTROLN
BUILDING PERMIT
DATE VALUATION a5,5i)0� 00 LOT; TRACT .4174
/0-7-c?(_.,
44"3" II��'.�.I•ILL0
APN
ADDRESS
OWNER
CONTRACTOR /DESIGNER J
i,,1�.N111111M
y�/ENGINEER'
y qJt
1:.535 S 13 s'1°kl• r
6 U05A. PE'itF,Z RD. ii E9
8,13,
CA'I%#1 MAL l:ITV CA. 922,44
909-198-6009
(6491324--3-43d' CA -1.4 1044
USE OF PERMIT
'f )i ij. �iAtilic)l SPA
t 'eJ�✓ :. �w171✓s �n .yr r 7 J•J: ,L+ ,b<1
�17..�i'flI317<e1il'O) CO.4'C' OF CONS`I•I:UMON
l i?11.00
)ll. -AN 001ICK FEE 1010K)4_39-318
C''�f 4;i 4'► J+ "3,'ir��rtr RID-' 101-•M-418-nflcf
NfHC!4.1?Q V.POOL 10A*_001-421-000
i;fsl f .{'EZ'ti::Al. JoEf ..,.. POOL 101 -000420 -WO
k"I.4.}i\O:sll+iOFERIOXX MI-OW-419-Utt:) Sw7.1?f}
4(.. n-'C.aTm, t"tON:`a"I` UI I'!'ON AND PLAN CRECK
$3�7.9.1h5
f
LF98 11U. - AID,C'1�.HS
U.flVFTT
`I'A�:;i'ItRA111 :PECSOVENOW
S378-15
1996
BY
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
ZJ`.
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
OX to Wrap F.A.U.
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drvwatl - Int. Lath
Final I I
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
0a 06f
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
I Pool Cover I A_
Gas Test
Final
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
I P-11.
4'
f�.
W
4' WME
-
WALKWAY
f
p;A 14'
PIA
AV
bb
6.
Cate
bench
280
55
V4'
PIA
16'
W
poot
LIGHT
SWITCH
Q
PJA
Anew
NLTm _wL I
RLTER RATE 100 Gpm.
TMRNWrR 3 HRS
INCLTYEES:
SIZE 141 x 23' * AREA 341
_RtTUPNtm1a
SHEER DES. Vk"/V,%-LVF,
DEM- NG 1515"
6" ,%NID 12p#
BUBBLE
DEPTH -3'6"TO -5,611.
Z
64' OF 5' TAIL
NVIDYS M RQM N
-RAISED BOND BEAM
SOLAR
s-LAP=_CL1STAPJmETE9. 76
%V/IRO.% _XCE
responsibility for damage t10
XV) 36" WIDE SHEER
C'O'%rF:R
SLE szz GROUP 3
tj
WfSELF CLOSD;G
WATERFALL
tj
-nLF c:5-cp COZAD 'Kv
cement slabs, sewers,
GATE (.NOT LNC1,
UIDED NV/P00L)
4-
RALSEBEAM 16'0W,"/ 6'641211
ccpjNG,CA_N-nkENTR 76'
0
v4eu, spriiklers teleohone ires
POOLCAPAC" 11 GALS
or svubS. When OCCRSS is rade
PUMP CAPACTY 70 GPV
mc-Dq mP STAINLICX 2 HP 1.0
througha neighbor's property t is
0%7v_rq It 300 ur
(h
I P-11.
4'
f�.
W
4' WME
-
WALKWAY
f
p;A 14'
PIA
AV
bb
6.
Cate
bench
280
55
V4'
PIA
16'
W
poot
LIGHT
SWITCH
Q
PJA
Anew
NLTm _wL I
RLTER RATE 100 Gpm.
TMRNWrR 3 HRS
NTMI
_RtTUPNtm1a
SHEER DES. Vk"/V,%-LVF,
_36"
TIAN DRAIN YES
swu P.E:z moDEL DUAL FORT
Z
CHECK VALVCQO
A
HEATE3 LAAfS SFE NO 67U
.. .....
GAS -114E By NONE
Fox L 04T .100w
responsibility for damage t10
:TA LIGHT INO
CLOCK24HR '-120V
tj
=LECTRIC By -9-D.C. 120'
ELECTRICAL BONDING -_-Y: S.D.C..0
tj
_nLEAND OC-P:WG S.D.C.
DEC04G BY S.D.C. L174 SQFV
NAVSALT W;6VTOFSTEP
Z
A
coWAUCP. cmn::t assume
responsibility for damage t10
sums, sidevaks. �rivewxys,
cement slabs, sewers,
L
Lavrr,-trees, fences, reLairirg
0
v4eu, spriiklers teleohone ires
r
or svubS. When OCCRSS is rade
througha neighbor's property t is
urderstond -_'-iat vm, 1 he owner,
Dffhaw na: neighbors pe rm rss 0-1
and issm-ne full respons, big !:Y.
10-2�9�6
2
Am__X1A1VC0
Acciress: 44-190 OCOTILLO DR.
T.A QULNTA, CA
Tract"Rancho Ocotillo'
14 191@
r Do��o�
EXTENM
P/
BOBCAT IkCC-7-S'
Pools01
DEC Ki NG
A
RE,%140VF, & REPLACE
SHOW ROOM
TV GATE7
GATE ANID BLOCK
3011 ODUNTRY CLUB CV..#F-4.
PALM CESEKT. U,,. 9226_--
P.L.
4'
/
64' OF 5'TALL
W/IR ON. FENCE
W/SEL"F CLOSING
GATE (NOT INCL
UDED `i'/POOL)
AW -L
1
W
S
I
'V
WIDE 114INIA4UA4�
RAISED BOND BEAM
1
h
5161!
P.L.
GENERAL SPECIFICATIONS
DECKING IS 15" �,
+ 6" AND 12"
WIDE 114INIA4UA4�
RAISED BOND BEAM
1
36" WIDE SHEER
.
+6`W/
WATERFALL
xx;-,xxxxxxxRxxxxxxr"r.xxxxr.r�r.r.;�i-
4'
DETAIL FOR CONCRETE ii
TURNOVER 3 HRS
CAPON RAISED BOND BEAM
RETURN LINES. YES
i[
+12"
36" SHEER DES. W/VALVE "
14'
MAIN DRAIN YES
bench
SKIMMER- MODEL DLT -AL PORT
61'
23, +6''
CHECK VALVENTO .
+61 or+L"
HEATER LAARS SIZE NO BTU
i
i
: 11 �t
12'
a 2 '
-51611
1
gate +011
3Aop;'T
516.1'
44,1
P/A
4' WIDE 1516" 16
WALKWAY 6 /
- +/ 41611 j
P/A 4 61 1 P/ '
P/A - A
«' P/A
W W S 1
I t ''TY i N 1 1 ' I g t• -u
UU
BUILDING & SAFETY DEPARTMENT
j .�.Jgi`w I �'�� i''iJ riL.�J'iTi\•'a,:i r,.,..
1v
is ALL Ni''r'''LiC.BL E CODES
DATE D 1-7 lq�,
nv
POOL
LIGHT t
SWITCH
7 +�
1 i P/A
RANCHO OCOTILLO PLAN 3 MANZANITA
INCLUDES:
BUBBLE
SOLAR
COVER
GENERAL SPECIFICATIONS
SIZE 14' X 28' AREA 341
DEPTH -3'6" TO -5'6"
SHAPE CUSTPERIMETER 76
TILE SIZE GROUP 3
TILE COLOR COZAD 830
RAISE BEAM 16'of+6" / 6'of+12"
COPING CANTILEVER 7.6'
P.L.
POOL CAPACITY 11 500 GALS
PUMP CAPACITY 70 GPM
MOTOR HP STA A'LAX 2 HP 1.0
FILTER SYSTEM 3 300 SQ FT
xx;-,xxxxxxxRxxxxxxr"r.xxxxr.r�r.r.;�i-
FILTER RATE 100 GPM
DETAIL FOR CONCRETE ii
TURNOVER 3 HRS
CAPON RAISED BOND BEAM
RETURN LINES. YES
i[
15"�I of cantilever ii
36" SHEER DES. W/VALVE "
11 "')11 i[
+6 or+L 1�
ii
MAIN DRAIN YES
SKIMMER- MODEL DLT -AL PORT
cantilever--o'
antilever €iiii It
CHECK VALVENTO .
+61 or+L"
HEATER LAARS SIZE NO BTU
i
GASLINE BY NONE
: 11 �t
S
P/A k
14'9
W
f EXTENT) P/
BOBCAT ACCESS '
DECKING A
TO GATE REMOVE & REPLACE
GATE ANTI)BLOCK ,
oor, • 11 I�� 6 ��
�t POOL LIGHT 40OW
\E it SPA LIGHT NO.
�t "CLOCK24HR 220V
ii ELECTRIC BY S.D.C. 120'
uuuuuuuuuL( ELECTRICAL BONDING BY: S.D.C.
TILE AND COPING S.D.C.
DECKING BY S.D.C. 1374 SQFT
NAT/SALT W/ 6FT OF STEP
CONTRACTOR cannot assume
responsibility .for damage to
curbs, sidewalks, driveways,
cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
or shrubs. When access is made
through a neighbor's property it is
understood that you, the owner,
DATE have that neighbor's permission
and assume full responsibility.
.10-2-96
Name: IANCO
Address: 44396. OCOTILLO DR.
Qu LA QUINTA, CA
Tract:"Rancho Ocotillo"
Do son
ulw
POO/W
SHOW ROOM
7301.1 COUNTRY CLUB DR:#F-4,
PALM DESERT, CA. 92260
FyvH^^!E (619) '•46-4032
LIC # A-574127 jeff(�mh