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9608-071 (RPL)• LIC'ENSED 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 741,27 A. b' 11!?7 . Date 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 have and will maintain workers' compensation insurance, as required by Section 37,00 of tb Labor Code, for the performance of the work for which this permit is Issued MPy tworkers' compensation insurance carrier'&policy no. are: Cartier 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 Sectio 700 of the Labor Code, I'"sha I/ forthwith comply with those provisio s Date: 1t �% �+ Applicant+ Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person -at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authefize representatives of this City to enter upon the above-mentioned property for Inspecttiion pu poses� f, �y Signature (Owner/Agent) , fir ' �• -°"`)' 4/Date ��" BUILDING PERMIT PERM 96}9.111►71 °°NTR°`# 38.89 DATE VALUATION LOT TFVTK'T . JOB SITE 4"ZO OCOTILLO APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER 'Criff 'URY' WAITS1 � � t''!t;1�Ui�St7": 69805A VE #69 SAN BERNAt3TNO CAi9.fEji1W, CITY'• CA 92234 -181-6001 (619)324.1232 G13(..'f 1044 USE OF PERMIT Pt'it.)1, AN D10k PA P.00, t. AND 'Style ONUY CY-rlNATE 1) C0$'1' OF CONST 93,000.100 11:tiMM l`0 SEE, SO1Y9MA:I Y Pt. AN 0,11130K.FFf 4'Ev .31A4.00 _ ..._ IVIEC7 ANIC;.a11..1,14'% —:POOL 101-000,4211-M S11s 00 FLISMRIC:At; lr -- O'eJc>.L 101 -•000 -420 -WO $45.00 e� in"11MBIN- f FrA ., FOOL 101-000-419-f X) $27.00 � rn co C,2 Q( CO l � SUB -TOTAL C'01'4:MUCT'iON AND PLAN CHECK $333.60 LESS F1ZE-13AII) FE S $0.00 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 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 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 xterior Receptacles G'.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) SPA SPECS.GENERAL SPECIFICATIONS - - SIZE 7' SIZE 14 X. 28 .AREA 314 RAISED /q ��" _ - 100 WATTS DEPTH 3'6"X5'X3'6 LITE ATT SHAPE FREE PERIMETER 75 S -TRI -LEVEL .SEAT TILE .SIZE CHOICE GRP 3 ` - _22" 24" TILE COLOR ,CHOICE GRP 3 6„ DAMWALL WIDTH COPING CANTILEVER SPILLWAY SIZE 3" X 1 COPING COLOR NTRL GREY SPILLWAY'POOL CAPACITY .12,000 GALS OPEN X CLOSED PUMP CAPACITY 95 GPM #•JETS 4 MOTOR HP MAXI II HP 1 FILTER MOD MEDIA 300 SQ FT FILTER RATE 105 GPM... - _ TURNOVER 2.5 HRS 28'-0!SUCTION LINES - RETURN LINES 2 MAIN DRAIN 1 SKIMMER MODEL U3 CHECK VALVE N/A - _..-- -6� �_ �� HEATER LAARS SIZE 250 pp�TU - /�— R4 6 GASLINE BY SDC POOL LIGHT. 400 WATT SPA LIGHT 100 WATT �— R7'-0 1/2" % CLOCK MANUAL 21 6 �� ELECTRIC BY SDC 1 '-2 j ELECTRICAL BONDING BY: SDC �- .7 �� \ -12' TILE AND COPING SDC - �- DECKING BY SDC, .859 SQ. FT. 4, �\ NTRL GREY SALT 12'6" CONTRACTOR cannot assume 15'6" �\ responsibility for damage to _.: 16'6" curbs, sidewalks, driveways, _... cement slabs, sewers, ® ® lawns,trees, fences, retaining walls, sprinklers, telephone lines 4' 801 _ ® ® or shrubs. When access is made ==- +=A~•— -- W V4?.- , [door W through a neighbor's property it is UTY�{ ® ❑ START POINT understood that you, the owner, ` F LA � 3� W� ® have that neighbor's permission S and assume full responsibility. 3�i OHNG & SAFETY DE RT ENS C N®ITION W W Name: o o ��aqo C3G1G(� ACCEPTS FOR, �� U MON s/�z© Address. y � SUBJECT 0 INS d AlPER city:: dG1 QNJDa4G1 250. j�jj(��� j�/� -TRACT L°3pM MWOLd© LOT# 07 mp. OF AND A APPLICABLE COD SAA RQ[QR_� I-DI _ . DATEBY Po�/s -� Do�son SHOW ROOM 73-011 COUNTRY CLUB DR. STS. F-4 ;PHONE PHONE DESERT CA. 92260 infiSTER COPS' -(619) 346-4032 .'