9610-028 (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
2_38947 C-51
,� /4 R
/Date Signature of Contractort�
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 bwrier 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.
XI 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`isxsued Ny v`�gA&' compensation insurance ca�rer-8fp licytno. 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 Californi and agree that if I should become
subject to the workers' compensat}on p ovlslons`of ectibn 3700 of the Labor
Code, I shy HIP with comply with`those•pro isions.
�fSate: le 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 issuanceof 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 Cir and State laws relating to the building
construction, and hereby authfo 7 representatives of this City to enter upon
the above-mentionedproperty for nsp ctionkpurpo'; �. f"
VSig'nature (Owner/Agent)'` /�� Date
1
BUILDING PERMIT PERMIT
�j/
1 9
DATE �.FiI "Jf!! VALUATION LOT LOT TRACT �•
JOB SITE '%..14015.'! 0.rCiA, ILI'�
APN r
ADDRESS
�.
OWNER
CONTRACTOR DESIGNER / ENGINEER
_
. cllti CIDER
P001—S
19.1(1 0120 t11LO
13:55S Hwy 111 '
LA C;itJlitifl'A CA,
P-ATANI i:A::tisiZ7' CA 972611
(61r;)3401 IS CIBI..i1 16
USE OF PERMIT
t�C�at�t, Egli t'i'f �3fVt�1.4;)31r1u? SPA S:�`} tSPA.
t'�l4'le .ru'Irdpr4Jl.'l, l 't9. 13,1 •!r i .:!
,
�:�'1! �lt►�frs`' u�l t,OS'1; OF CONST .1:U1n.7'1.ONI
PE'RNM4' drl E SIC3t7MARV
PI. AN C�.ff -4,14., FEC 101 <4it`1Q.t{'19L:�1 ti
MECtIA141c-a
FtaEc:7'RiG:AL VRE -- Pc'XA. tU1-OW-az( t .9) sa .fin
PT. IAMINO EFM -- PONT. I£lt-fJif£i X113=i1{?t? $L'/-Ua
zz�t.ia, i s "VkV*,:-P.:11D 1 NS
Woo
D
� �`������ :��:1tt►�:r��' 1i��a�� �o� rlc.;`�v
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OCT1996
;.:
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 F
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
U
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)
Unless noted all dimensions are finish 61111`111111111WOnmand all
eievaitiooare to top Of bond buft
MASTER POOLS a SPAS will Intie" #0 mming Of
any
part of the plans about which 111i InIsind'll'i'stalix" May
Any do,*4ations from one shall be =b:�OpmoWing
does 60 On his Own responsibility WW allUM96 81
! ' Incur.
included
herein remain the of
MASTER POOLSrg*PA%.'
duction publication Of dislibudOn � �m
|or matter consent Of
1.',3TE1 POOLS & SPAS is prohibited.
with them �plans shall constitute acceptance
^rCUmn^,":CsRroRDsRwo ^o49715
RIL [s)E RA PC 3 5^``S PM
ii ~~
AND ALL APPLICABLE CODES
to,_ nV Allu-lo
Designers & Builders Since 1958
73'555 Highway 111/jeOSeO's Shopping Center
Palm Desert, California 92260
619'346'6115
Stite License # C53-238947
APPROVED:
A CUSTOM DESIGN FOR:
SPECIFICATIONSSizeolum^—s^./m*
Templet* No. shape
spaisize nations.
ExcAvxnmm
Finish Elevation
^""es,Site Preparation
Grading
Dirt~..`Removal '/Loads .--__--_-�_�-_--
Fence Removed o, ___-__onx=edo,—Material
Size of Opening
wors m"painting mmatching mtexture will m,done!
Automatic Cleaning
�
*rccL _
Standard/Special: - !> ' __�-_
_ p"iseou," o"=,. 6''___--12'__-__--18"___-oth" __
Spa Dam Wall.
oum/rs
Corner
'~ps Line Location
'_
Grab Rail _--_-*"ndn°o_-___.c=Anchors
--__-�
Se"m"ncx__-_-__---
Spa Information
____---__'— ---
TILE copmo
^^~"
.°m. ~.~ �
Brick ---
Special Detail See "STEEL"; .~.,..^
ELsorn/c^L
By: -AA 0174 Liqht400--Cord Length Feet,
"J" Box Location ^40- - Switch Location
Filter Run ----Ft. Jet Run - ---Ft. Light Run Feet.
Switch Run ---Ft. Panel Change
Spa Switch Location-- -7C -X--- --- -
Heater Switch L"""n""
oEcx/w
o
By. CLTtk-1C-!5-5_ r.".sh pt._-_____-�
owo,n"./A".h~"_-____
Risers. s"w"~"".___-____----'--
Standards.
Deck o,="--___--- --- - ---------------------��
rLAxrsn
Lights j-___'_-_marne Plat" l-___Recessedsteps
Cup Anchors Anchors
NAME
ADDRESS 79-105 0C,0-rILL0 bl�,'
CITY LA 001KITIN
PHONE
AREA
1 SHEET OF
PLUMBING
Filte, Type
Jet Pump
Blower Type
Plumbing Material
Suction. Size. 7—' Length --Ft. Discharge Size,;�:!-- Lgth. —Feeit.
Waste To-----, -- - Size I Length
Returns in Pool: Nurylper L:S,:7jSize .-L-=. Length
ReturnlnletType Ell
Feet.
Feet.
Fill ve
G�Line By 'L""gith�@a__'Feet.
Automatic Cleaning
^ SPA INFORMATION �
,
Suction Size
jet Type.. Number -f
Number Tl=--*"oTh_-----~ee`.
jet Air Line '___-_--_s,"
Slower Return Size ____--_�__-__L""o�-____�Feet,
s°.�"
`",v"/.r,v°� -_--__--_-w"mm.,.'_—Size—
___u.z"-__-pnm,r'p"
Filter TypeSize
Pump Type
�
Skimmer rvn°_-_____---_-_--s," -_-_-_____no.___.
Heater Type.,----- ______u.z° _
Heater Vent uv '--r---------�--_�------------�
Jet Pump T,"".-__-'__'�__-_-s,°
om°° ry _—^"ze
Equipment Lm"v""r/Cmab!Pit
Plumbing Material ---------
_-_-_suc,."".s.,°-___-
Suction: Size ---Lengm__'o. o.=^=�s=__- w�.__p"m,
Wasteaze
Feet.
Returns ." Pool: Number __-__-Size --__--__L°"mm_____
p.°,,
Return Inlet Type
Fill Line (With w"obs,,"m.~ns)sm__Loth.--- Ft. A/sv"/ve Location.
Gas Line o, _-____-_____nze _____Feet.
Automatic Cleaning
�
*rccL _
Standard/Special: - !> ' __�-_
_ p"iseou," o"=,. 6''___--12'__-__--18"___-oth" __
Spa Dam Wall.
oum/rs
Corner
'~ps Line Location
'_
Grab Rail _--_-*"ndn°o_-___.c=Anchors
--__-�
Se"m"ncx__-_-__---
Spa Information
____---__'— ---
TILE copmo
^^~"
.°m. ~.~ �
Brick ---
Special Detail See "STEEL"; .~.,..^
ELsorn/c^L
By: -AA 0174 Liqht400--Cord Length Feet,
"J" Box Location ^40- - Switch Location
Filter Run ----Ft. Jet Run - ---Ft. Light Run Feet.
Switch Run ---Ft. Panel Change
Spa Switch Location-- -7C -X--- --- -
Heater Switch L"""n""
oEcx/w
o
By. CLTtk-1C-!5-5_ r.".sh pt._-_____-�
owo,n"./A".h~"_-____
Risers. s"w"~"".___-____----'--
Standards.
Deck o,="--___--- --- - ---------------------��
rLAxrsn
Lights j-___'_-_marne Plat" l-___Recessedsteps
Cup Anchors Anchors
NAME
ADDRESS 79-105 0C,0-rILL0 bl�,'
CITY LA 001KITIN
PHONE
AREA
1 SHEET OF