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9903-018 (CP)4'4 W uJ r o Z r` to O O WW� r 1- a U) Z' LICENSED CONTRACTOR DECLARATION "01rhereby 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 85.1199 Date 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 - 41".. Signature of Owner C`-'._• .r WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: (, ) 1. 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 Policy No. ATX R:FLINL) (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. Date: A Applicant— Warning: pplicant 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 ra 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. 1 agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon theeaabove-mentioned property for inspection purposes. ,Signature (Owner/Agent) ( �.,� Date ?�' ! � �1 PERMIT # BUILDING PERMIT 9903-018 DATE VALUATION 15*30, 000.00 . LOT TRACT (( " /jF if J013 SIT9 d� °57-540 COLOINIAL APN w ' ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER MCCONMIC-SEOICMV LLC 9 L'VE fXMSON C01N 'iaTJ1 ;r110N 7-30 B �;1.5TC 3140 73011 COUNTRY CIMS DR.., ,;UY.M F4 S.AN"CARGO CA, 92.101 1at1.t..A1; IJt S(.it"!" CA 92260 t760)3�"032 CBJ.# 101.4 USE OF PERMIT POoL .ARIi OR. `!PA. COMNORCIM. COMMON AREA POOL AND &PA. POOL ANMOR SPA �V,.000X* LS ESTIMATED (.` ST OF C O NISTRU(, a'' ON 30,000.01) PLAN t,f:fEX."14':. F -H 101-000-439-118 $484,923 F1TP !0). -OM -418-01Y) ;fist„M IRC )ANTCAL RX - 11,1 J01. 101.-=421.-0(9) $241* isLEC'MI'CE L FfiR -- P( „ 101--000-420-0,00 S45A) f r;„ l:fNWI NG FEE _. JiN OL 101-t)F1-419-000 5027.00 LESS PRF-PAIDECES $0.00 TOTAL Pt;.!RMff )+'1PX`S d I1JCNf3W $4565.4.3 RECEIPT: DATE BY r”' DATE FINALED INSPECTOR INSPECTION RECORD I 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 OX 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas ' PLUMBING APPROVALS as Test E al 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 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) COMMENTS: COUNTY OF RIVERSIDE DEPARTMENT OF HEALTH ENVIRONMENTAL HEALTH SERVICES DIVISION APPLICATION FOR POOL AND SPA PLAN REVIEW NOTE: Plans will not be accepted unless this Application is complete and Plan Check Fee is paid. PROJECT NAME FOR OFFICIAL USE `OFFICE DATE \ XV-I.q , -`FEE kuoo - — k - JdCIL_ ^1 Jo o C 12 41 10-11 �.C" R `Jz<�- p'.vr,-S �N PROJECT LOCATION �`'r'� `" % ' fS` \ 3 CITY OWNER/OPERATOR ' �` �T PHONE ( ) ADDRESS CITY ZIP CONTRACTOR 7p�S�''� �`�`'�"PHONE CONTACT PERSON �> U'3S" P,,I L s PHONE ( ) NUMBER OF POOLS: # POOLS UNDER 1,000 SQ. FT. # ` SPAS # ` POOLS OVER 1,000 SQ. FT. TYPE OF DEVELOPMENT: Motel/Hotel Municipal Apartment X Homeowner's Assn. Other (Specify) OWNER/REPRESENTATIVE DECLARATION: I understand that the amount of fee paid is based on my declara- tion of information on this form, and that incorrect information is grounds for denial of the submitted plans. NO inspection of my pool/spa will be conducted until all proper information requested has been received and the plans have been approved and returned to the contractor/owner. , APPROVAL to operate shall not be granted until the facility has passed the FINAL INSPECTION, an°"Applica- tion to Operate" has been completed.and Permit fees have be n pads='� I Signature Date DOH -SAN -182 (New 5/89) r B -Office - GApplicant — P -Bldg. Dept. r COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH District Environmental Services Division POOL AND SPA PLAN CORRECTION District No. Z Plan No.—/ J Date PROJECT NAME (� �– i– .) " .r -tit c. PROJECT LOCATION OWNER / CONTRACTOR e < < The plans are now approved subject to the conditions listed below. • j ' V ria f e l f r' C'. r }- ( G r `. �' r'• , C r r �t f e CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections at least tbree (3) working days in advance. _ ' A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment, and signs. APPROVAL to operate shall not be granted until the facility has passed the FINAL INSPECTIONS and `APPLICATION TO OPERATE" has been completed and PERMIT fees have been paid. REQUEST FOR FINAL INSPECTION SHOULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE. f Plan Check By ; Phone I acknowledge the corrections noted heyein and as indicated of theplans and agree to incorporate them during construction: Signature/./""' i nature Company ��� /� S✓�' /-'l "G ( Date 4 DOH -SAN -181 (Rev 11/95) Distribution: . � �4i�'Sf:i�f`y '� • •1 JR .,Y V�^, 7'�r u r �+��✓'iYi�.T+d%5i�1. f".��liTrdr�Ts.f �'%��1,.` r� i+ ��!', �. ;st. 'r+ R, �.:•T'!/ !'gin-r'.9.'�`+'' - COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY �, _ .•. -' : -DEPARTMENT 'OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES, SUPPLEMENTAL REPORT TO SAN. FORM # DATE ((� SUBJECT WAS —� G� . PRMIT NO. ADDRESS ` ` C6 INSPECTOR REMARKS: ,� d0,0 � _ l rr (( J A(01^ �" L r�� S f�c ISS /.t 1 /110 1110 c 1 4 t f DEH -SAN -1 18 (Rev 2/96) Distribution: WHITE—Office; CANARY—Owner; PINK—Office I� r TL COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY-` S �� .:.. _ _.3- DEPARTMENT�OF'ENVIRONMENTAL HEALTH t ENVIRONMENTAL HEALTH SERVICES SUPPLEMENTAL REPORT TO SAN. F RM # DATE S G A We , Us � SUBJECT /^1 �,� K: F PERMIT NO. ADDRESS INSPECTOR REMARKS: S C.-, Ye t( LA t k, �✓ cviAA e+ v sac- L-) a4, nv, 46,= L 70-,��!::� K e V .1 S t-C C" On v, (/-C a c v S 1.��2.5 a✓ w /Gw. ,of P14 &Z 1".4, 1" oukup r • \... YI. ' .�,yv_�,„. j- a ✓, LY..., 1..,,;. ,,Iy.r' DEH-SAN-ite(Rev 2/96) Distribution: WHITE—Office; CANARY—Owner; PINK—Office DEC -21-99 10:20 AM DODSON POOLS 7603410895 P.02 + COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY I . DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES SUPPLEMENTAL. REPORT TO SAN. FORM # DATE SUBJECT f" C �� c. •�`` ;. '�� •S �. PERMIT NO. r L ADDRESS c o l o i•� �• d-• r. REMARKS: J nn INSPECTOR! (. �.• ('f -_ . 0 tA r V., 76 7 � n o�asw•��e �N ' ' I Dletdbi Wn' WHITE—Of cie; CANARY -•-Owner, PINK—OfAc.0 • COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES. SUPPLEMENTAL REPORT TO SAN. FORM # DATE SUBJECT % `J / kJ f S" V"1C �S t PERMIT NO. ADDRESS `• O r3 n ` R—� L • `.i REMARKS: yok4-7. INSPECTOR oe►+•sEw•>>s tRav a�ei' Distribution: .WHITE-Office;.CANARY-Owner; PINK=Office., .. .•..