0008-169 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby=affir"f6'L nder�enalty 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
O 374127 A �.--""r~~ ;3112i
Date 3. 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 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 STATE FUND Policy No. 04640-0007934
(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,
Fate: � "c %,` Applicant,.✓.,!',, , d. _.. �. �.
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 of1'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 property for�irispection purposes.
Signature (Owner/Agent)100r Date 4
Y/ BUILDING PERMIT PERMIT#
DATE VALUATION LOT OQi"� TRACT
JOB SITE
APN
ADDRESS 79-180 Ck"1TeUS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
FWV�IJCE SYNM19r4EDT
In'EVE DODS )X CONSTRUCTION INC.
70-1 EO CTERUS
73011 C(:zOTIrI Y BUD W., S't711U
I,AQY11<i1A CA 92253
PAJMDESERT CA 9226E
(760)346.1032 ML# 1044
USE OF PERMIT
POOL AND/UR SPS.
POOL & SPA ONLY.ALR.RSk SMARRIE S SMALL BE IN PLA CL AT PRB
PLASTER INSPECTIOMPOOL EQUIPMENT ENCLOSURE IS NOT INCLUDED
SIV THIS PERMIT
VALUATIO14 34,180.00 LS
I+.'�MWAI,"0'D COST OF C(iN6r)WTFC.'7[°.f X
34,1W00
PKRmrr.uIan SU "Y
PLATT i'-'}IECT; FEE 10I-000.439.313 $206,03
CONSTRUCTION FEL? 101-0200-419-000 $317.00
MWHANICAL FLT -- POOL 101.000.421.000 $24.00
ELECTRICAL PYE -• POOL 101-000.420.000 $45.40
PL,tiMBRIC FEE -- POOL 101.000.419.000 (27,00
SUB TOTAL COMM'RUCM09 AM PLM aTr Le
$619.03
IY-SS PRE -PAID 1,M=
$0.00
'r(Y4A-, PERMS?r;`:�b DT7E ROW
RECEIPT
DATE
,6Y r
DATE FINALED
INSPECTOR
' INSPECTION RECORD
C 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
s
Equipment Location
Underground Electric U 5 `v
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Testy • �/ _ _
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:
-
(j `
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 1"
Smoke Detectors
Temp. Use 6f -Power
Final
Utility Notice (Perm) .
.,STRIP FOR FINISH
DOUBLE CANTILEVER CAP
SILVER QUARTZITE FACE
I' AIRPIPE
R6'-6"
P/L
5'-0"
SPA SIDE SWITCH
STAC FD WAT RFA
W /ROCKY MOUNTAIN QUARTZ
WATERLINE & CAP FOR CASCADE
F:?y TOP'
+I8"aa
_+ISTOP OF DAM
WALL
WATERLINE
PROPOSED 30" STUCCO BLOCK
5'-O" GOLF COURSE PLANTER WALL BY SDC
R31 -6 11 AT REAR P/L
IP/LIt = 11� 1� m m m m e m Its tT• t� t� t� t1• IT• Its t>• 1� t>• tl• 1>• t� tT• t� I>• t� 1� O titt�� tl�
/ ,— R6'-0" STUCCO BLOCK E UIPMENT
Kau :: •: ,11• tl- ..t •
•.It.!- • t� !-�, ! -�- '11'1
or-welAll 01
responsibility-
DATE
•1 •D•
LA QUINTA HOMES
MUDSILL CROSSECTN
MUD SILL
10'-3" Q
11 I +6' BY SDC '
!� 2'6" to 6' Stucco Block
� / +12' �__I WATERBRITE Side P/L Wall
J L W 7'-0"
8'-911 10'-9" 11
I�
X12" �,<\ 117' I
/ 13'-9�
81311 BENCH 1
3 1 ,,P/'A
�' a �■
_.\ 131_
Q I
a
116'-011 a I�
'1 1 1
BOBCAT ACCESS
R&R BLOCK WALI
I I
VA
BY SDC
19'-9"
DECO
281611
PATIO
P/A
Q
a
O
Q
0
FAMILY ROOM 1
1
NOOK
6'-0" 1 ADD VENT
STACK
TO HEATER
ACCESS
9'-0" JANDY RS 4
EXACT LOCATION TO
r� BE DETERMINED
ENTERTAINMENT ROOM
BUTLER'S
PANTRY
Ll
i
A RE -INSPECTION FEE Of $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
No EXCE MNS!
CITY OF LA QUINTA
BUILDING $ SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE
GENERAL SPECIFICATIONS
SIZE 12 X 29
AREA 323 PERIMETER 79
DEPTH 3X5
SILVER QUARTZITE WATERLINE
DDD 111/1L11 1'11 /'1. /^1 (1)• 10 ,
FILTER - STA RITE 300 SQ FT
FILTER RATE 102 GPM
HEATER LAARS SIZE 400 BTU
TURNOVER 2 HRS
SUCTION LINES 2 "
RETURN LINES 2 "
SKIMMER MODEL AMERICAN "
CHECK VALVE YES
GASLINE BY SDC FT. 100
POOL LIGHT 400'W CLOCK RS 4
ELECTRICAL BY. SDC r_7 200
Names JIM AND ALICE SYNNESTVEDT
Address: 79-180 CITRUS
Qft�i LA QUINTA
TRACT TROVITA LOT#
&dA011
Poo s
PALM DESERT
N 73-011 COUNTRY
1/8"=1' SCALE CLUB DR. STE F-4
PALM DESERT CA.
NOTE: LANDSCAPE AND FURNITURE 92260
ARE SHOWN FOR ILLUSTRATION (.760) 346-4032
ONLY AND ARE NOT INCLUDED. 1 Ir u A
TEMECULA
28910 RANCHO
CALIFORNIA RD.
STE 206
TEMECULA CA.
92590
(909)676 -SWIM
EM. FEEDER WATER BRITE
PEBBLE FINISH MIDNIGHT BLUE
DECK BY SDC SQ. 1033
DECK TYPE SLT FNSH OMAHA
STEP FT.
SPA SPECS.
DESIGNER
SIZE 7 RAISED +18"
JOHN/E
LITE 100 WATTS
TRI LEVEL SEATS 22" 24" 27"
DATE IDAMWALL
STACKED
6-26-00
ISPILLWAY
DAMWALL TOP UARTZITE
SPILLWAY SIZE WIDE
REVISED
XX OPEN CLOSEDA
Names JIM AND ALICE SYNNESTVEDT
Address: 79-180 CITRUS
Qft�i LA QUINTA
TRACT TROVITA LOT#
&dA011
Poo s
PALM DESERT
N 73-011 COUNTRY
1/8"=1' SCALE CLUB DR. STE F-4
PALM DESERT CA.
NOTE: LANDSCAPE AND FURNITURE 92260
ARE SHOWN FOR ILLUSTRATION (.760) 346-4032
ONLY AND ARE NOT INCLUDED. 1 Ir u A
TEMECULA
28910 RANCHO
CALIFORNIA RD.
STE 206
TEMECULA CA.
92590
(909)676 -SWIM