0005-138 (RPL)LICENSED CONTRACTOR DECLARATION
,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
574127 A 03/i1f2!
' i f I ..•/�,__.
/Date _� Signature of Contractoy��!� _ 1Z
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:
Cartier STATES FUND Policy No. 046.DO1000".
(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'..df Section 3700 of the Labor
1ode, I shall forthwith comply with those provisions.
te: - X •GtiApplicant 2'l ~
1 /
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 property for inspection purposes.
r� /1 ,-
jSignature (Owner/Agent y / � � � Date —
-fir j 5 .(A BUILDING PERMIT PERMIT//
00-13
TRACT
'DATE VALUATION LOT �J
$�I,�ii3ii.+r3lT J
JOB SITE
APN
ADDRESS 455-• 3CULDDROOK LAM.
-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.3M. WA. DFL IZE1r LLC
MWMEDODSON COa+isIRU SUN'
1535 S, *D" 3rPMT
73011 COUNTRY G:' U8 D.P., MITE, F4
SAN BFRNARDINO CA 92408
PALM M1;RT CA 92260
-
(760)346-4032 ClrIX 1044
USE OF PERMIT
P001',. AND/011 SPA
POOL & SPA SHAJL BE IN PLACE AT
PR&PLA3TER 1NSP9CTEON.
POOI AP1WOR SPA 21.41071.90 W.
}MIMUJIM (110S.1' or) COMMUCHOH
211000A0
PERMT FEE SI,i1V.ikitisa1 Y
PLAN CHECK FEE101.000.4:49-31€3 $140.40
CO' NSTRUCTiON FEE 101-000-1.18-000 $216,00
MZCHlAT11.=, FEE -- P001:• 101.-000.421.000 $24.00
KLECTR C:AL. FEET; — PCOL. 101-000-420-000 1145.00
r. ,
PLUMBiNO M- POOL, 101-000.419--000 $27.00
LEI
V1 '
ffn--WFAL t"i MTTR.U(:TIOM AM> PLAN C''HECX
� $452.40
IMS PRF_ IPAED F33FZ
°J'+(1.00
TOTAL AL P001 7T FEES Dom': NOW
5452.40
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
`/ �6 r
N_;
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
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
(Q
Gas Piping
Gas Test
Appliances
Final
Q'90
COMMENTS:
a
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)
ADD VENT
STACK
TO HEATER
5'-8"
OWNER TO PROVIDE
EQUIPMENT WALL
5'-0"
5'-011
lr
0
11 1
-119
32'-2 "
PALM SPRINGS GOLD BOULDERS
NOT ,TO EXCEED 2411
61-611
3,
LIGHT SWICTH
morning
room
G/E
BOBCAT ACCESS
NO R&R .
all
door
wl-14—lilu,
14'-6"
8'-6" T-9 " 91
5
1 11 ' `\
4 -0
B NCl
I/
61 1113
1 11
n
/11
great
room
27'-6"
RESIDENCE
I
1
SEE OWNER FOR RANDOM
PLACEMENT OF BOULDERS
i
1
i
+18" 3'-611
15'-6"
i
I
P/L
71
i
33'
D) CK -2" BELOW MUDSILL
CONCRETE
master
..u,. • rbs-sideveft. •rn
1 1-1 11.! M il M • .•i1- !I!•
rq In M14UST %_q
responsibelfty
''
STA - FD WATERFALL
W /ROCKY MOUNTAIN QUARTZ
WATERLINE 8 CAP FOR CASCADE
as-eE
EttE>8i8z?^ TOP::
PLASTER COLOR WHITE
DECK Y SDC SQ. 724
DECK TYPE SLT FNSH SD BUFF
STEP FT.
WATERLINE
SIZE 7 RAISED +18"
LITE 100 WATTS
18" WIDE.
SPA DAM
DAMWALL STACKED
::WALL
DAMWALL TOP 'QUARTZITE'
SPILLWAY SIZE 6' WIDE
REVISED
SPILLWAY XX OPEN CLOSED
::�NE:WITI I
<`
SIT & SPIN SPA VERTICAL
FINISFbECK—,
DECK
VENEER
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND 10B CARD ARE NOT ON
GENERAL SPECIFICATIONS
SIZE 14 X 28
kRFA 331 PERIMETER 76
TILE CHOICE GROUP 3 SQ, 54
RBB, SPA AT +18"
cnpwr, CANTILEVER
103
1.5
FILTER STA RITE 300 SQ FT
FILTER RATE 102 GPM
HFATFR I AARS S17F 250 RTII
SUCTION LINES 2 "
RETURN LINES 2 11
SKIMMER MODEL AMERICAN it
CHECK VALVE YES .
GASLINE BY SDC FT. 60
POOL LIGHT 400 W CLOCK T 104 R
ELECTRICAL BY. SDC PT 200
DESIGNER
RANDY/EV
PLASTER COLOR WHITE
DECK Y SDC SQ. 724
DECK TYPE SLT FNSH SD BUFF
STEP FT.
SPA SPECS.
SIZE 7 RAISED +18"
LITE 100 WATTS
RI LEVEL SEATS 22" 24" 27"
DATE
DAMWALL STACKED
4-21-00.
DAMWALL TOP 'QUARTZITE'
SPILLWAY SIZE 6' WIDE
REVISED
SPILLWAY XX OPEN CLOSED
THE SITE FOR A SCHEDULED Name: CENTURY HOMES /
INSPECTION. SCOTT AND RENELL BURCH
5'-0'•
.NO EXCEPTIONSI Address: 45-735 COLDBROOK LN
LA QUINTA
TRACT MARBELLA LOT# 53
CITY OF LA QUINTA9
BUILDING & SAFETY DEPT.yDO SOI%
APPROVED 'w.,~
FOR CONSTRUCTION POO/S
T
DAT-0PALM DESERT TEMECULA
E J 5 � BY
N 73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4. CALIFORNIA RD.
1/8 —1 SCALE PALM DESERT CA. STE 206
NOTE: LANDSCAPE AND FURNITURE 92260
TEMECULA CA.
ARE SHOWN FOR ILLUSTRATION (760) 346-4032 90
ONLY AND ARE NOT INCLUDED. I � . - I . (9900 9)676 -SWIM