0005-141 (RPL)42
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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. Pate
574127 A 08/31/2(
Date,5-/5- 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. 04$40-00070M
(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 thoseaprovisions.
Date:. 't , "k Applicant ��/2 ? .j.-� ,. ✓ten,
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 representativves of this City to enter upon
t eeaabove-mentioned property for inspection puf'poses. s
iS gnature (Owner/Agent) Date .1 5 u
L
BUILDING PERMIT PERMIT"
DATE VALUATION LOT 0005-141 TRACT
S2311"100
JOB SITE
APN
ADDRESS 0--540 CI171.DDROOK W,
-
OWNER
CONTRACTOR /DESIGNER / EN INFER
5flKt 3A DEi. REY 1 LC
SM. VE DODSON C:'OsTS'IRUCnON
1535 3. "D' 1T_rFX T
73011,CIDUNTRY CLUB DR, SU3.'TE P4
SAN PIP"A.RD71`IO CA 92 408
PALM DESTRT CA 92260
(760)346 4032 t"B O 1044
USE OF PERMIT
POOL AND/Olt SPA
POOL & SPA. ONLY-A.I.ARMSM A RR.IERS SHALL BE IN PLACE A'I'
PRE-PLASTHR I'ANSPECTICON,
POOL ANDIOR SPA 23,ii0P.00 LS
FSr73MAI C09.t' OF C0.RY1' ZUCI'EON
23,0E10AW
1'Fi.?i1W FEE SUMMAURY
PLAN CHECK ITT 101.000.439.318 $112.10
CONSTRUC71017 FEE 101-000-418-000 U34.00
MECH NTCAL. FEY; - POOL; 101.000-421.000 $24,00
SLLCTRICAL Iq% - POOL 101-000-420-000 $45.00 t..:
"1"!
PLUMBING F;LSP -- POOL. 101-000-119-000 $27.00
-'
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SU13-3 OTAL CONfrMLIMMON AND PL AAF CHECK
$492.10
Y.�i YRRa-P JD I E.RS
$0.00
111VEAL I KIMUT FER``S DUE NOW
2,10
A I
RECEIPT
DAT/ECJ
B
DATE FINALED
INSPECTOR
1�
9•
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
Steel
POOLS - SPAS
BLOCKWALL APPROVALS
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
Sewer Connection
Pool Cover
Encapsulation
(
(C I lel
Gas Piping
Gas Test
Appliances
Final
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)
P
REVISION ALERT
(ADD PUMP
RELOCATE EQUIPMENT)
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
RE NOT ON
N A
PLANS AND 10B CARD
THE SITE
FOR
AS
SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
CITY F
.
O LA QUINT
A
__
BUILDING,
&SAFETY DEPT
APPROVE
FOR CONSTRUCTION
DATE` S -cly_ b -Y I_
ADD VENT
STACK
TO HEATER
91
300STER PUMP
FOR 2HP FOR JETS
WATERBRIT9'
/L
1
R6'-0"
m
13'-7"
R9'-3"
R3'-6"
7
R5'- "
DECO DRAIN FREEFORM I ��
--- 16'9"
LIGHT SWITCH 20'-9 " 12'-6"
1 v v I
RELOCATE EQUIMENT
TO GARAGE DOOR
RESIDENCE
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XV iTeNT7
MaVo
DATE
SIT & SPIN SPA VERTICAL FINISH
DECK
DECK
VENEER
GENERAL SPECIFICATIONS
SIZE 15 X 30
NREA 328 PERIMETER 79
,%cwru 3X5
TILE CHOICE GROUP 3 SO.
i � s
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C
I
SrACKFD WATERFALL
W !ROCKY bKri1NTAtN Qtls_. RTZ
WATMINE A CAP FOR CASCADE
COPING CANTILEVER
?
+IVTOP OF DAM
a� -
WALL\
1/2 i<
HE 1.5
'liff7C�:
HP 2
FILTER LLT STA A RITE 300'
Q S FT
rc)o:
GPM
"1lVfc'!'�R
SIE
WATERUNE
f NOVER 2
UR
{
SUCTION LINES 2
BB
R ET URN LINES 2
of
SKIMMFR Mom AMERICAN to
'
18.1 WIDE
PALM SPRINGS GOLD REVISED SPILLWAY XX OPEN CLOSED
SPA DAM
4-27-00
WALL
`<
:SEP RA E
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1.
.Y
RET
..........URN
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C
�:,:......... HEC E
TRACT MARBELLA LOT# 43
...
R6'-0"
m
13'-7"
R9'-3"
R3'-6"
7
R5'- "
DECO DRAIN FREEFORM I ��
--- 16'9"
LIGHT SWITCH 20'-9 " 12'-6"
1 v v I
RELOCATE EQUIMENT
TO GARAGE DOOR
RESIDENCE
• tiT�jlj.
�t
XV iTeNT7
MaVo
DATE
SIT & SPIN SPA VERTICAL FINISH
DECK
DECK
VENEER
GENERAL SPECIFICATIONS
SIZE 15 X 30
NREA 328 PERIMETER 79
,%cwru 3X5
TILE CHOICE GROUP 3 SO.
64
RBB. SPA +18"
COPING CANTILEVER
POOL CAPACITY 9,480
GALS
PUMP CAPACITY 103
GPM
MOTOR HP STA RITE
HE 1.5
MOTOR HP STA RITE
HP 2
FILTER LLT STA A RITE 300'
Q S FT
FILTER RATE 102
GPM
NEATER LAARS SIZE 400.
BTU
f NOVER 2
UR
HRS
SUCTION LINES 2
to
R ET URN LINES 2
of
SKIMMFR Mom AMERICAN to
GAS LINE BY SDC
FT.
1JU
POOL LIGHT 400 W CLOCK T104R
ELECTRICAL BY. SDC rr 250
ICHFM- FEEDER WATERBRITE 1
0o s
T PALM DESERT TEMECULA
BACKHOEACCESS
NO R&R N 73-011 COUNTRY 28910 RANCHO
1/8"=1' SCALE CLUB DR. STE F-4 SCTAE12006NIA RD.
PALM DESERT CA. TEMECULA CA.
NOTE: LANDSCAPE AND FURNITURE 92260 92590
ARE SHOWN FOR ILLUSTRATION (76 346-4032 (909)676—SWIM
ONLY AND ARE NOT INCLUDED. 1 u „ C7A 1
IDECK BY SDC SQ. 899
DECK TYPE SLT FNSH COLOR TBS
STEP FT.
SPA SPECS.
DESIGNER SIZE 7 RAISED +18"
LITE 100 WATTS
�
AIRPIPE RICHARDIE RI LEVEL SEATS 22" 24" 27"
DATE DAMWALL STACKED
DAMWALL TOFQUARTZITE "
4-21-00 SPILLWAY SIZE it X WIDE
PALM SPRINGS GOLD REVISED SPILLWAY XX OPEN CLOSED
OULDERS# JETS 4 UPER LOWER
4-27-00
lime: CENTURY HOMES/ELLEN PRICE
P/L
Address: 45-540 COLDBROOK LANE
Ojfty;LA QUINTA
TRACT MARBELLA LOT# 43
DECK -2" BELOW
MUD SILL
DO so�
•
P
0o s
T PALM DESERT TEMECULA
BACKHOEACCESS
NO R&R N 73-011 COUNTRY 28910 RANCHO
1/8"=1' SCALE CLUB DR. STE F-4 SCTAE12006NIA RD.
PALM DESERT CA. TEMECULA CA.
NOTE: LANDSCAPE AND FURNITURE 92260 92590
ARE SHOWN FOR ILLUSTRATION (76 346-4032 (909)676—SWIM
ONLY AND ARE NOT INCLUDED. 1 u „ C7A 1