0302-004 (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
F -H
, 8 CSI -8 �. or51,°2(
date � � � � Signature of Contractor�JC id
}
OWNER -BUILDER DECLARATION r
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 Sianature 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.
�Q.) 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. My workers' compensation insurance carrier & policy no. are:
Carver u'11A'1 r C!G� Policy No. f�+€bf�5tf5I��-e1�
(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, l shall forthwith complywith 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 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 representatives of this City to enter upon
the above-mentioned propertypection / �._ p,,•! ur os�
Signature (Owner/Agent) .� e �' Date
BVJLDING PERMIT PERMIT#
DATE ._y VALUATION , . LOT TRACT
JOB SITE APN
ADDRESS %t_pX;0 1?Ei. JyRIV- -
OWNER CONTRACTOR / DESIGNER / EN (NEER
sow VIA.0.D111Vr.J10Pk&_" CORP. CAtXFOR1tilIA3? DOLS & SFAS (TCT MAX Ca,
PO BOX 1144 86-100-Aii'IN'(7E 54
LA QVINTA Cel 92253 MAMMA CA 922 46
(/6q)398-:222 CBI -4 00355
USE OF PERMIT
POOL JA1JIXA SP.A
POUl+f•l'AIN t3'NI-Y
X ANDJOR. SPIN 31000.09 Ls
ES.I.TUAIED CM OF t:.'s NSTRTfMON
3:x.00
FEV gUAMAWY
PIAN CHFICl. 8111
101-000-439-318
MAO
CWNS1'itLtMCM I?`ZE
301-OF3s;3-A•18-000
454100
R "C° tIC:,AL FEE • POOL
101.000.420.000
ANA
PLIUMBINQFRE - PO011
107 -MG -4119-000
$2%00
.rim-Tt: rpa,, cC3%Tom0t flu ANi"11=%AN, amm $1 c1.'! CD
LOA.' `.' 1'°r''C-PAM FEM SOM
T(T"F
FEB 0 3 2003
BY
I
I
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 I I
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
It PLUMBING APPROVALS
Gas Test
Electric Final
aste Lines
Heater Final
Water Piping
Plumbing Final
dumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
_
Gas Test
Appliances
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacle&
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Finalf�/Q�
COMMENTS:
i
C
SPECIFICATIONS
TYPE�. .,+' f •3'�d.+� slit
SURFACE AREA OF POOL 4
PERIMETER I t ..� DEPTHS MIN. > '- MAX, _ � „ �00
SPA Sr-P�ECiFiCAT(£IIdS TILE
SALE .'.e._L_ x SQ. Ft TILE TYPE ' L)
SPA DAM WALL WOTH ° ; �T r,,. WATER LINE a crty
NO. OFJETSTILE TRIM _ W X N
QUARTER ROUND
LIGHT �x R.B,6: It P
RAISED SPA AT o
SPILLWAY TYPE z
LV W
SPECIAL NOTES
Dn NG >
EXCAVATION STEEL ��� � � � <
T I FINISH _-«— _ 0
ACCESS FROM EXPANSION JOINTS
ELEVATION �
CAN19LE)0, _ °C
JEEP END RAMP DECK DRAINS
LOVE SEAT — DEi CC DRAIN _
CONCRETE REMOVAL LOADS CURE' CORE
SOD REMOVAL - LOADS STEPS
TREE REMOVAL BY STEP FADE'
TILE BASE
IRRIGATION REMOVAL EtY, '� I
- Y IRRIGATION REPAIR SAND AND 14SQUEEN
6• R.B.8. _. _ RIBBONS _
12` R &S8 M014 STRIP
18, Rl.B.
24" R.B:B
TAN SHELF DEFT"
ROCK POCKET'S_ i MASON"¢
CQ NG TYPE
CENTERS R"8.6. FAONG �
�1
SFtLLWAY TYPE w��r �..ia,_. 2E
PLUMBING� STEPS
FILTER ATE liP b� PROP. EzT WALLS
a ' PLAN7EP, WALE _
POOL PUMP
� WE m a i RETAl�iWiNG WALLS
r
SIZE
EQUIP, WALLS
ADO'L PUMP SIZE FIRE -PIT
ADDI PUMP SIZE
____. SIB
HEATER_
i y..
�iE CLOCK
Sus PANEL
ADO L OU LE1�€
SKIMMER I`YPF
fNJ LINE PEBBLE PLASTER? r I
1 uwm POOL
GAS LINE STU$$ ITS ioi .:...+...
FOU ITA#NS/ SPRAYN£Ad S -� R UX0, _ .
SttEER aOESCE�m EY£Ai�S .,�
m-m Sim
"IS iN POOL IN A _
STJ6 SET EQUIPMEI9T r END
N 3w
,+
" M±SC. .t
PLUMBING 3ZE
1
i.�._,�.._...,..._~µ .....mom_ ............. {
GlrINI t i GATE RE10,SA _ _ jj¢
Dec' END R40s PEMOVE A&ANTI
EXTENDED 2n� STEP
LQVE:S€AT
sPI SAY T rn .. �'
�
OTHER
R,B.B. —SEE STEEL
+� ;SIB = sTl 4'
OWNER TO: (1) "ERUtNE THE AF41ROAMATE ELEVATION OF POOL OR 55-'A AT t.AYO T DN DAY OF EXCA0,710+i
(2) TAKE NO'"CE THAT or, „ :AND EQUPMENT I_OCATIONt S Al SUBECT TO A,C° PTA,NOE OF
LOCAL BUILDING DEPAR''MENT A' 7)ME OF aS�ANU OF F tWR ,T
0DOWN CONCRETE SHELL As LEAST TWICE DA L-v FOR SEVEN )Ala Ar w5 SrE L fS INSTAU.:J":.'
(4) ACE HAt CALIFORNIA POCILS }S NOT RESP'10"LE FOR ", OEpGPD NI,' viT;ohs 0, 0 :;&xC S, —"
AND ANY DAMA{E TO, CURBS, 3DEWALKS: OPIVTWAM LAWNS:. uR Or P I'EOS ?N r. ACCESS AREA
a� 1a � CrCt E __OSU!
(�� ..SEE T}i�+T xa ��� E,ATE_; AND vARA�,E aka MEET LOCAL �o>�Es
TO PREPLASTER NSPECTION
w $} FILL POOL j*ME✓IATtL" AFTER F'LAST€k, (FOLLOW IN'SROCTIONS -- DO NOT :ISE RWB R ^4m-z
('#) TA4 NC'PCE THAT "HIS 17RAiY,tra ,u THE E FART OF I;A..F'uRt+lA Pr>XS AND 114' ANY
LISE Ti IOUT AIRt +t,FN rERMISSJON OF CAfl iFflR,i A `SOU k . aS P .0418.TET B' :�10
OW14FEa APMV S PLAN, POOL. AND EOVIPMENT LOCATIONS AND HAS R£A.D THE RESPONSBfUT,F- AND YO T .> ABO'eE. �?
BfGNA iUfiE(S} DATE
SUMMING POOL PLAN �MR:
NAME TRADITIONS
a STREET o
C=
JOB ADDRESS -Vc f . ;
P H 0N1_7 OFFICE R S
T5 T C 7AD7, PAGE BOOK
MAP BOOK PAGE NO. CItY - - �--
MAIL _ADDP:-:Ssi
CONSTRUCTION OFFICE PHONE NO
SCALE DATE DRAWN BY SOLD I.4Y NE B'Y.
Ly
a :`m a
JOB� —
r "°
21
1
T_
CL
_ } 7_ 1 N 1
CON TR CTI O N AUTHORIZATION -TONE
A I 'S 14 Ul I_I) TILE
II4= + BOULDERS
t
DECK COLOR
JANDY
PEBB. /PLA'S
MASONRY
SIGNATURE
I)EC �¢ -
t'Rk;ryPI.,BI31_E . ._.,:_._.�..�EI�-circ�ge rl �� ��r} ��r.i�+E � ;I:�:ters �sl�d pots, othpers, unless. ORAINAIGEE NOTE; �
r Her'