9807-036 (RPL)LICENSED CONTRACTOR DECLARATION
reby affirm under penalty of perjury that I am licensed under provisions of
Cli'apter 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
234 47 C-51 3/31/00
V106ate41
`1 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 Sectiori , 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
Se ion 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.
i iO L",14 j k(111.L'
r`!%V Z3U!1iK1
(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 'f I should become
subject to the workers' compensation provisions of Sectio 3700 of the Labor
Code, I hall forthwith comply with those' provisions.
'bate: ► Applicant`s t �✓
Warning: Fai ure 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 authorize re resentatives of this City to enter upon
the above-mentioned property or inspection purposes.
'Signature (Owner/Agent--'x' s Date 'R,l
v
BUILDINGPERMIT PERMIT# CONTROL#
y
DATE VALUATION � x,7.50.00 LOT TRACT y� O Q A
y1iF)'T-1M) 8084
JOB SITt t
APN
ADDRESS 79-075 000TILL0.0k
OWNER
CONTRACTOR/DESIGNER/ENGINEER
S"f'Ts"ti'1;1 *I,A1
MASrUIt POOLS
79-075 C3C011.i: In DRIVE
73.555 HIGHWAY 111
1,A,Q1JEN17A CA +?2 53
}?t1I,,M DDSERT CA 92260
011.0 46
USE OF PERMIT
POCA,
'Pt.tW:iPA ONL , Ai. �]t'AT.,,iafiltT2.l tty Si[f(i,): ISI 1?�f :� 1�.T2�-iii AxSiFt2
IN`3ft,'(1110N
t�,i�1' D C.,08T 10FCONI N it Ut., fl ION,
•h � /.�i�iAll
tar., AN CI WXX FT3H 101-000-43%1-3118 :ttf I f. #, r
Ilaf�C'[lAP1f+:'ill, l J: — t'zil t`�, l.i)i•�i) •4�J•CJiliJ 1,00
'
a
1l.l.t.i'Ii[l_t'11nl�l.f:--Y+',ic,T.. i.til'4�)(,i•d��-t}t)ti �1�,
Y
Nt IiAIICONO 1•'h -- PQX74„ 101-000.41940) $N7
LEMS `i>. 1;-.4AID FFLS
$0.00
NOW
s3`t11.1s
.+K1A r
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 5
Set Backs
Electric Bond 0
Footings
Main Drain
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
Finalri
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole�i�l�
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
4
Final
Utility Notice (Perm)
COMMENTS:
Sit/SPCG>/o A( ai✓ PSE -!5�4/41•
FELE ,eE�oo,BT �C'EG/6i/Edj g /9-98
B� �R RT�-1 Sc�ST�/rjs �c� iySvL�4NZS
TiF/N�, STF6� iv �/D��• � t,
/,�ls7sf(L-f�J
��{Fo +� 0.194
V�
E -w
VC!'Z PFORDER NO, AG49715
Designers & Builders Since 1958
73-555 Highway 111 /Jensen's Shopping Center
Palm Desert, California 92260
619-346-6115
State License # C53-238947
APPROVED:
A CUSTOM DESIGN FOR:
DATE
pcnu;=c--
AND ALL APPILIC tkLit-C. Q 6-0
6,y *,Q>
Unless noted all dimensions are finish dimensions and all
elevations are to top of bond beam.
MASI ER POOLS & SPAS any
the meaning of any
pi�rj of the plans about which any misunderstanding may
anso.
Any daVm'ons from plans shall be referred to
K1,%STER POOLS & SPAS for verification before proceeding
v:,,'n work. It work proceed without verification, contractor
I
dons so on his cv;,l �-:ty and assumes all liability he
may incur.
-i-lt:o to the p!"L, tut 6"FIC'specifications included
horcin rqrn�.:' PrzPGof
MASTER L..:.__, -2 S P &
Any L-101 r' -��I�ctcn, publication or distribution in any form
Cr r., i 1 -19 or in part without the written consent of
--LS &SPAS is prohibited.
ct ejth t1jese plans shall constitute acceptance
DATE:
Grab Rail ---- - .--
SPECIFICATIONS
Seat/Bench
Size vZx7_4 Volume — Gallons.
Spa Information
Template No. Shape
Surface— 2.ay Perimejer L/F.
Depths: M ni m —211—Maximum !S111 Break — .
Spa Size -Volume Gallons.
Tile
EXCAVATION
Cantilever
Trim:, �itf4l-CkNumbe,ed Tile
Finish Eley Method:
A Site Preparation
Grading
Dirt Removal/Loads to Dump
By:
Dry Well Location:
"J" Box Location
Fence Removed By Replaced By _Materiel urrl_�
Filter Run
Size of Opening
Switch Run --Ft.
NOTE: No painting or matching of texture will be done!
Spa Switch Location
PLUMBING
Heater Switch Location
Filter Type Size - 2S)
Pump Type --Size -
,
Skimmer TypeVSize N.
By
Heater Type- ---Size
Color'L"V.1
Heater Vent By
Risers
Jet Pump Type ---7'-----Size
Standards: -------Board
Slower Type ✓ Size /67 Ci.j;7p
Equipment Location it
Dock Drain
Plumbing Mattif at
Suction: Size Length___ Ft. Discharge Size— Lgth. —Feet.
Waste To Size Length — FeelI-
Returns in Pool Number Feet.
Lights —Name
Return inlet Type
Cup Anchors --Rail
Fill Line (With N%9t>structions)Size th, — Ft. A/S Valve Location.
Gas Line By ; ii'l Size --Length Feet.
Automatic Cleaning
SPA INFORMATION
MUIPAW
th. — Ft. —Dischg.Size TN. ;,.Feet.
Suction: Size-2�
Jet Type—� Number
Jet Air Line Number � Size —Length Feet.
Slower Return Size -- Length Feet.
Selector Valve: Type-. —_-Number: —Size*
wo
Filter Type Size
Pump Type —Size
Skimmer Type Size No.
Heater Typpe Size
Heater Vent By
Jet Pump Type Size
Slower Type Size
Equipment Location P/C Stab/Pit
Plumbing Material
Suction: Size — Length —Ft. Discharge Size — Lgth. —Feet.
Waste To Size_ Length Feet.
Returns in Pool: NumberSize—Length Feet.
Return Inlet Type
Fill Line (With NnObs uctions)Size t th. —Ft. A/S Valve Location.
Gas Line By - s�g -Size --Length Feet.
Automatic Cleaning
TN
IL 11T
STEEL
Standard/Spectal:-
Raised Bond Beam: 6" —12" -- 18'—- Other -
4,,1
CMTLY. LI
Spa Dam Wall; Feet
ACC"EPTED ii--Om-i
i, Co UBJECITC, iN1127i L' m-` 01 1
Smai
GUNITE
I
Corner Radii Inlets—_ --Jets
Steps --- - : !i44Ai11--Fi1l Line Location
pcnu;=c--
AND ALL APPILIC tkLit-C. Q 6-0
6,y *,Q>
Unless noted all dimensions are finish dimensions and all
elevations are to top of bond beam.
MASI ER POOLS & SPAS any
the meaning of any
pi�rj of the plans about which any misunderstanding may
anso.
Any daVm'ons from plans shall be referred to
K1,%STER POOLS & SPAS for verification before proceeding
v:,,'n work. It work proceed without verification, contractor
I
dons so on his cv;,l �-:ty and assumes all liability he
may incur.
-i-lt:o to the p!"L, tut 6"FIC'specifications included
horcin rqrn�.:' PrzPGof
MASTER L..:.__, -2 S P &
Any L-101 r' -��I�ctcn, publication or distribution in any form
Cr r., i 1 -19 or in part without the written consent of
--LS &SPAS is prohibited.
ct ejth t1jese plans shall constitute acceptance
DATE:
Grab Rail ---- - .--
—Hand Rail — Cup Anchors
Seat/Bench
Spa Information
TILE AND COPIN.(k
Tile
Color ping/Other
Cantilever
Trim:, �itf4l-CkNumbe,ed Tile
Brick
Special Detail: See "STEEL"; "GUNITE"
ELECTRICAL
By:
Light _cord Length Feel.
"J" Box Location
43 1 Switch Locatio
Filter Run
Jet Run Light Run Feet
Switch Run --Ft.
Panel Change
Spa Switch Location
Heater Switch Location
DECKING
By
--Finish Sq. F, L-A 0o
Color'L"V.1
Rail Anchors
Risers
Ft. Expansion:
Standards: -------Board
/Slide
Dock Drain
PLASTER
Lights —Name
Plates —Recessed Steps
Cup Anchors --Rail
Anchors _Grills
NAME
ADDRESS
CITY Lk Cx-'MIIIW�
PHONE
AREA
SCALE OF
�� 1` - 9� � •}�� t Fi,�R�i'�' t�t� ��'\ �'ri� ��' ` "�I�i��� , 1��{/�
r t
Eawth :Systems Consultants
Southern California
79-811B Country Club Drive
Bermuda Dunes, CA 92201 • (760) 345-1588
Client Name
Client Address
Client Phone
DATE
JOB NO.
PROJECT
Ste Ve, I
Ian ResideRe5idem ee
LOCATION
79-075
Oe.oti.1a
CONTRACTOR
OWNER
WEATHER
TEMP oat AM
oat PM
PRESENT AT SITE
THE FOLLOWING WAS NOTED: 1 OGO..tej raI If' S ee� 0c`_'La1! C ou—s rci 00 I
• !�J � Pvw+a. I"ti�u5 ries roto vr��e i�ae.%o etev
S a
�o. i - •'#3 �b r Gro. � D (� �/2 /ahs .�a Covt1' Norl �o,�
# 3 il" : 11 it<Ll'� O.Ct. hif�
Floo✓ E'cA w' e VLwf Y-/1ovi Z
3reb, v 6ra� '10 Ca^ �aCL, INo
sAU o� /oor ,- �3 re.ba;rr ryr • �► �: 'L/' a, C, eaLc� c- •
Dee p Floo �� r t �1..� rid Z'/ p e �,�o
oh beawt Z' 3 0 Gg (o qac. Cvh7�
AD 0✓5vtoiipl!q /60.6 ibvf t5 ,E�Sf of ao
�i i u YG Lx r' ox /z
u Ked, c- 1'j /-fAoCa��r� vt 5 or i:5.U6 1. U S4 eef
oi4 1 bars a.)epe aceA' 4i YoUkel ✓aik$
CLIENT REPRESENTATIVE SIGNATURE
FIELD -REPORT
TECHNICIANS SIGNATURE