9910-006 (RPL)LICENSED CONTRACTOR DECLARATION
�I hereby affirm under.penalty of perjury that 1 am licensed under provisions of
Chapter 9 (commencing with Section•7000) of Divisjon.3 of the Business and
Professionals Code; and my License is in full force and effect. 1,
License ,#. Lic. Class Exp. Date
574127 k �}i r3s/ki?i
Signature of Contractor ,`Y y _ ✓� �' ��
.a
OWNER -BUILDER DECLARATION_
I hereby'affirm under penalty of perjury that I am -exempt from the Contractor's
License Law for.the'following reason, 1
( ) l,'as owner of the��prop,6i*.or my employees with wages as°thei�'sole
compensation, ..will do the .work; and the -structure is not. intended.oroffered'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:
have and will maintain a certificate. of consent to self -insure for -workers'
compensation,` as provided .for. by Section 3700 of the tabor Code, for. the
performance of'the work for which this permitis issued:
( J I have and will * maintain workers' compensation insurance; as required by
Section' 3700 of the Labor Code, for they performance of the'work for which this
permit js issued. My workers' compensation. insurance carrier &' policy rio. are:
Carrier Policy No*
STAX
(This section need not be completed if the permit valuation is for $100.00 or less)
(
)J 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 provisionsrof. Section 3700 of th Lae bor!
Code; 1 shall'forltiwith comply witfi those provisions. > ,i'
Date: //�✓ Applicant i /:" :': • /' "
arising 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:Safe'ty
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 pf.this application 'be.comes null and yoid.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 a11':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
v ignature.(Owner/Agent) �' �•-�� •`�'" Date
1 0�
WWW
PERMIT #
BUILDING PERMIT.�,:�
DATE VALUATION '�f,��(�� LOT, TRACT:
, (, Se, rt
JOB SITE ADDRESS 9 400 SPANI'M SAY
APN "
OWNER _ _
CONTRA!�CTOR4 DESIGNERS ENGINEER'
..
a.
r� y fir• rQ�/ �p
- 6�tS1KF^'d.Fl �Tlk�./ryJ'Rh^+yeVt 5 .
T. 1f ��t
t{�C[t,:�.td �4�dr�e�\pf«�.�Ca�yryit.:�) ,f qU, l...•y�.
il.db�ftrti y�Cp4yFJ
irk yFT4 Y✓�Rr''i
1�t.-ry.1.71J1`Y.AX 3� CLUB DR_ IS�•JA,YR ,S'4
CC9tCUNIA CA 917)0
P1bUriDESEI A ¢1 0216f) ,
(16Y)34&4031 : MLM ' 1044
USE OF PERMIT
POOL PA.
a Eas. sl Fit' i, . d r3i't� fin R F:�3.9 RE MD FOR PPS: .PLAS'Img .
i7S�t �f/�
j"app�{� ``, j•-
POOL ANDJOR SPA V,200.0,1) LZ
`tl �i�✓h .li.TlJA. LL(iY,�!\ '.
��1 }MI�.Yi4Y
yy��Yy��gg7X�.yy qqg•r��ytg]{i�yts�i�,7,Ry,�b1�9�1?'.e�4.�b.n.Y0.'V��+1.�.71
ti'Lv` .F4).0'Yii � l,�.R��.�e .:1 R7kYY f9.pIAH9, qw ,' � : _•
MAN Oftc S176.48
.;
'xy�TWnw
rit`Cc3�7r]�1;}L��i.��s�CRAi't-7-!�
A
Ei„i`tC�trIiw 3.f4►3fI
PtMf1tN()"P001.
01. 101-00U�l1�-.000
x
11.sSS >n1 nc`�it > ri;
. :., t3:i}fi
TOTAL Is.6,11AUT FFES.D9JENOW
RECEIPT .
DATE
BY
DATE IN D
INS
TOR
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
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 I ath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment L
Under . and EI ric
U erground Plbg. Test
Final
as Piping 16
PLUMBING APPROVALS
Gas Test
lectric Final
Waste Lines
hater Final
Water Piping i
Plum
Plumbing Top Out 1
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
41
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:
CONTRACTOR cannot assume responsibility for GENERAL SPECIFICATIONS
damage to curbs, sidewalks. driveways, cement SIZE 7 "
slabs, sewers, lawns,trees,fences: ret_ainina '
walls, sprinklers, telephone lines or shrubs. AREA 49 PERIMETER 21 ,
When access is made through a neighbor's DEPTH '3'6"
property it is understood that you; the owner. - TILE CHOICE GROUP 3 SQ, 44
have that neighbor's permission and assume full ` RBB• 10'@+18" .
responsibility. COPING CANTILEVER
DATE* signature P m m m mopRur
PMPLr'AtTFr
MOTOR HP qTA grrF HP 4.5
MOTOR HP HP
FILTER STA RFFE 300 SQ FT
Fll TFR RATF 103GPM
.
- -
..
AIRPIPE
» I
+3
- +30"
+18 rr S-6" -
7�.0r, — - 3►
,4! All _ -
'
�I.
VI _
- r'.
- .
f-•«---'
SUCTION LINES 2
RETURN'LINES 2
SKIMMER MODEL AMERICAN "
GASLINE BY SDC FT. ALL
: - �- -- =CITY OF -"" POOL LIGHT 400 .--CLOCK T.104R
QC.I
.BUILDING T� ELECTRICAL W. SDC ALL
&SAFETY DEPT.
APPROVED. . .PLAT COLOR TBS
LOR-
CONSTRUCTION dQ�
-r-"i"•y-.,'."•- .••^-_ - ---• -r-'. .
j
-
DATE '� =-�-.L BY
STmFA m �T� .. m m m
?� p•
, , .
IPr{c(;r CO Py
SPA SPECS.
,• ,. �•�,�
-
DESIGNER' SIZE RAISED SEE DETAIL
•
. X
;
;
LITE 10 WATTS
RANDY/EV RI LEVEL SEATS 22" 24" 27'
-
�:.
�.
A. RE -INSPECTION FEE OF $30
DATE DAMWALL ° x FT.
-
. '-6
2-4!-9 "
\'`
_
WILL BE CHARGED IF THE APPROVED
DAMWALL TOP "
9-20-99 -
LIGHT I' S WITCH PSA
�
PLANS AND JOB CARD ARE NOT ON
SPILLWAY SIZE " x WIDE
THE SITE FOR A 'SCHEDULED
WISEDSPILLWAY P EN CLOSED
# JETS UPER. LOWER'
•I r
`� ��
- 'INSPECTION. -
-
-
_
:NO EXCEPTIONS!
Mme: cENTEX HOMES
Address`
• -
i
S.rJ1JL: LA QUINTA
}
3
i TRACT LOT# 4
l
y
;
&dsoff,
PLAN
.
3
LOT 34
poo/s
�`
! PALM DESERT TEMECOLA
'
N
73-01 i COUNTRY 28910 RANCHO
4
- ,�— � -
:1/8"f SCALE
' CRUD DR.' STE F-4 - '- CALIFORNIA RD.
' ST,E ' 206
• -
;PALM DESERT Ca.
TEMECui��cA.
. NOTE: LANDSCAPE AND FURNITURE -
92260
92590
'
ARE SHOWN FOR ILLUSTRATION
ONLY AND ARE NOT INCLUDED,
IM
.
l# -A4741 " 7