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9609-117 (RPL)LICENSED CONTRACTOR DECLARATION w I hereby affirm under penalty of perjurythat I am licensed under provisions of Chapter 9 (commfrncing with Se6tion,7000) of Division 3 of the Business and Professionals Code, and my Licen'se.is in full force and effect. License # Lic. Class Exp. Date 23,S947 C_5� 31-11 WJ6 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, At owner bt the pi'600ty, ;§M ezclUsiJely d6htracting With licerised 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 is Issued. AYIy 06'Wers' compensation insurance carrier-& policy Ao. 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. Date: 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 oa'his application. j0 1. Each person upon whose behalf this application is made & eachmp frs� �on 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, inrmnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null anc Did if work is not commenced within 180 days from date of issuance�ofsuch 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 authorizeAepresentatives of this City to enter upon the above-mentioned property;for I spection 17"D es. r Signature (Owner/Agent) Date 1 r _ BUILDING PERMIT PERMT� - °°NTR°`� '460*317 �`� DATE W26/96i VALUATION ` -I l,'i1�#),{�� -LOT TRACT JOB SITE 79­06SOC 1(1L,� ADDRESS APN OWNERCONTRACTOR / DESIGNER / ENGINEER t� ��yv• 79-065 OC:U:11I_1',l10 13535 } W Ir 11.1 LA QU1N f'A NAW D SIM"T CA 9270) . {til�?j3E9G-C11S t`1�L;4 lfi USE OF PERMIT + t°OOL AI` biOR ;'.N1 KKOL .rlN-1 SPA. ONLY a � 'u .» at .ic r� i a•� .vu f.a a�.S'%'��4.•�i'U8� C�.�a E33r d:'L3NS'i'k;L11n'3-i�P �.�,Qii3t!i.11�3 PLAltaCIRCK FER W100439-318 .$$"7.75 CChfST1gl;.fr•"C0KTFEL 1431-040 4113-000 5135.J0 ,&;s'r'i U41CA10 Mt , -- POOL 101.000-421-M Lo �. S'iLEX,71RICA1. 17P8 - PCX)L 101-000-420-000 $4..1.00 C 1 1' ARA. i11Nt7 FK - P0011 1C11�f►IJ!)-�ll�i-{1(}{) S�7.t3f? © �- • ccs I C-2 Cl - Q(, U -1 I � -S> rvrarm, COMSS"T:t1.'UTC.°1T0N AND PLAN CHECK $315:7:5 PRE 01 pp ii aa Pq, Rof Ei, c, DIM40W 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 ;;lab 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 Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond XZ Footings Main Drain 71-1 Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) &ANTILEV� �(vt0�& r0 ` A.T ESE OF POOL/St'A. Designers & Builders for over 35 years 73-547 Highway 111/Jensen's Shopping Center Palm Desert, California 92260 619-346-6115 State License # C53-238947 APPROVED: A CUSTOM DESIGN FOR: DATE '?' I t - 9& SCALE /S''= l'-0 DATE: SPECIFICATIONS Size ! Zf—K ZW50 Volume Gallons. Template No. Shape Surface Perimeter �' LIF. Depths: Mrmmum _3_Ir—Maximum S' O Break Spa Size.axe Volume Gallons. 1�2 - EXCAVATION Finish Elevation . Method: Access: Site Preparation L4 Grading - Dirt Removal/Loads to Du Dry Well Location Fence Removed By —PqFit— Replaced By _Material Size of Opening NOTE: No painting or matching of texture will be done! PLUMBING Filter Type CART' Sita /50� ,ELECTRICAL Length_ ,f_ Feet. Pump Type -.Q 12- A lbLid, --S =C: Size LS NP J Switch LocationgT QQ) 1 Skimmer Type-_?_�VVLA S21J1FSito Ar No. Jet Run Ft. Light Run Feet. Heater Type L AA CS Size J O Panel Change Heater Vent By��AL L%�S Jet Pump Ty Size Blower Type -P- A. Size Equipment Location. A. P/C Slab/Pit Plumbing Material -V •C— DECKING //^� fig ZOO& Suction: Site 2 Length _ Ft. Discharge Size r. Lgth. Feet. Waste To Size Length Feet. Returns in Pool: Number ----size. Length Return Inlet Type F 1- e Feet. • Fill Line (With NoObstructions)Size_I gth. _ Ft. A/S Valve Location. �. r 4 S Q Feet. Gas Line By 'Size Length Automatic Cieaning y SPA INFORMATION p Suction. Sits�j -�7t2� $th. _ Fit.—Dischg.Size 2-4gth�. eet. Jet Type_Y±`tct1 �_ Number . Jet Air Line Number Size "Length Feet. Blower ReturnSize ngth feet. Selector Valve: Type �4Q1ci1s._Number Size - Filter Type l Size Pump Type Size Skimmer Type Size —No. Heater Ty p• Size Heater Vent By - Jet Pump Type Size _ Blower Type_ Size Equipment Location P/C Slab/Pit Plumbing Material Suction: Size Length Ft. Discharge Size_ Lgth. _Feet. Waste To Size —Length Feet. Returns in Pool. Number—Size - Length Feet. Return Inlet Type Fill Line (With No Obstructrons)Size _Lgth., Ft. A/S Valve Location. Gas Line By — Srze. Length Feet. Automatic Cleaning STEEL Standard'Sp!•r ia!'----- Raised Bond Beam: 6" 12" — 18" Other— Spa Dam Wall: j( GUNITE � Corner R ii: �T� • Inlets! R_Jets 4 . Steps i Fill Line Location Grab Rai Hand Rail Cup Anchors . Seat/Bench Spa Information TILE AND COPING Tile _�[E5_ Color -1-, 13 Coping/Other-- Cantilever ing/Other _Cantilever— Trim:—Numbered Tile . Brick' Special Detail: See "STEEL"; "GUNITE" PLASTER Lits Z Name Plates O� �'t Recessed Steps A Cup Anchors s %� Rail Anchors Grills NAME Xtt5E;2 �I%E.I�I�F ADDRESS -79-<9k5 000 -TIL -L,0 Ill= CITY LA OUlKh-A. PHONE AREA OIC I1i� �.A. LO"r �Co 5 N. BY ��JI.LI�� I CHK. BY S =1[SHEET OF �� By: .LyS� `!p— Li ,ELECTRICAL Length_ ,f_ Feet. "J" Box Location( i't'L J Switch LocationgT QQ) 1 Filter Run _Ft. Jet Run Ft. Light Run Feet. Switch Run Ft. Panel Change Spa Switch Location Heater Switch Location DECKING //^� fig ZOO& By: jC''T HE S_Finish Sq. Ft. Color Cantilever Rail Anchors Risers— F� l Ft. Expansion: Stand Board/Slide - Deck Dra n - PLASTER Lits Z Name Plates O� �'t Recessed Steps A Cup Anchors s %� Rail Anchors Grills NAME Xtt5E;2 �I%E.I�I�F ADDRESS -79-<9k5 000 -TIL -L,0 Ill= CITY LA OUlKh-A. PHONE AREA OIC I1i� �.A. LO"r �Co 5 N. BY ��JI.LI�� I CHK. BY S =1[SHEET OF