9910-007 (RPL)LICENSED'CONTRACTOR DECLARATION "
:,hereby affirm -under -penalty of perjury.that I ant 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
'U613V 204
j�Date f - Signature of Contractor
.OWNER -BUILDER DECLARATION
I hereby affirm. under penalty .of perjury that I'am exempt frorn the Contractor's
.9, License Law,foi the•following reason:,, .: ' -
( ) .l, as'ownerof the property, or my, employees with wages as theiraole
m
copensation, will do-the'work; and the structure is notintended or offer ed.for
sale (Sec.'7044, Business& Professionals Code). ,
as, owner• of. the property° am exclusively contracting with licensed.
contractors to construct the project• (Sec. 7044, Business & Professionals
Code). .
O "fam.ezempt.under Section B&P.C.'for-this reason
Date Signature 'of ,Owner
WORKER'S COMPENSATION DECLARATION'
1• hereby affirm- under penalty 'f- perjury one• of the following. declarations:
(:) I haveand will maintain a certificate.of consent to self -insure, for workers'
compensation; `as Will, maintain.
for by Section. 3700, of the. Labor Code, for the
performance of the:.work for which'thls permit Is issued.
I have and will maintain workers' compensation .insurance; as'regwred l y
Section 3700 of the'Labdr Code, for the performance of the�work forwhich this
permit 'is -issued' My workers' compensation insurance, carrier & -policy no., are.
'Carrier 'Policy -No:. t .•
(This section need not be completed if the -permit valuation is for $100.00 or less).
—(-)=I-'I-in=the-performance`of-the-work-tor"which-this-pe Pm if 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 (o the worker§' compen'sation provisions of Section 3700 of_the_Labor
Code, lsha'IIf • -� with comply V h.those p ovisions.;qt
LIP Appllcant"'�r
t/ '
Warning:• Failure to secure Workers' Compensation coverage is unlawful avid
shall subject an employer to crimihal perialties and, civil fines up t6-$100,000,_in
addition to the cost of'compensation; damages as provided for in Section 370.6
of the Labor Code, interest and attorney's fees:
IMPORTANT; Application is hereby made to the D•irector,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 & eachperson at
whose.request:and 'for.whose benefit work'is performed; under: or p=.to
any• permit, issued as a resultof this applicaton agrees to,. & shall, indemnify
&'hold -harm less'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. cornplywith ail City, and State laws. -relating to the building
construction, and hereby authorize representatives of this City to enter upon
the. above mentioned property fo insPectiorn p irposes, .
Slgnatu're •(Owner/Agent) '
PERMIT# .-
BUILDING _PERMIT
DATE r'I t VALUATION `,4� y �@D63�9F(Q{ .LOT TRACT
JOB SITE
ADDRESS . ..+�I�:l[AA�Ek�
APN .._
OWNER -- -'. _-_ -_ _ _ __-_ _ _ __ ,:
CONTRACTOR/DESIGNER/ENGINEER
IL CON i
7PL^if1 A 11, J Ji 11LVr'i;Et 4 �.tLL "hill t 9, 45.0,
35011. acct" V'ra i.:�.,� 110 1! }A, Ti.�E S'4. .
C 720
CA '922
USE OF PERMIT
KA"D.{J A1vX OR SPA
L 4 siNk ALAPM''3 A1tiiY3;OR A'RJbT,�S R Etii3.tl5.;t:J?
PO -71, A.iNW1. sM aPA. : kI.00A LS .
—PLrNrCi FOK—:?•...6--1-01-000-43S16-3D23 .t3 —
£`� 5Ift(;t jf�7d F" 1.0!•{lfify- tR 3P,SO
'
_1111,01N18 Y.t3t>1.. '.' 1 l:�):4 (HJ4�-�ilA S4 i �r2�?:wa
R9P7-'_K YAJ QQNSINPICTRON.ANp1~i'�,f[W,Q.i��r'�'�i:•i7ry�r
$6 9. ?
21ES
..1- �{�`,
1�;{�
. '. I R.Y'{iA MJA PJ.F° itl .s••V .TJ ±Vs„yrtlY' .- ..:
wUP✓[: �, FkY .
RECEIPT
DATE
BY 14
DATIN ED
/
;NSP CT R
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings Ducts
Slab Grade I Return Air
Steel { Combustion Air
Roof Deck Exhaust Fans
O.K. to Wrap f 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 Steelj�Q
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 EncapsulationM6 Da
Gas Piping
Gas Test
Appliances
Finalbto
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 „
llU14 Notice (Perm)
CONTRACTOR cannot assume responsib_ ilit_ v for GENERAL SPECIFICATIONS
damage to curbs, sidewalks, drivewayaQgmgjA
Slabs, sewers, lawns trees, fences, retaining SIZE 26X40
^ - walls, sprinklers. telephone lor shrubs.
AREA •705 PERIMETER 157
When
ines
cess is made through a neighbor's DEPT 3'6" X 5'
AIRPIPE pipedy it is understood that you, the owner. TILE CHOICE GROUP 3
have that neighbor's- permission and assume full R1313CROSSECTION
responsibility. COPmm m m m Mo.-,
y .c. +24" <—. l3' - --3► DATE _ signature P APA TY 13-000 . .
+ 18"
7
BACKHOE ACCESS — PUMP CAPACITY 103 -GPM
NO R&R `` MOTOR HP STA RrrE '1.5
` +18" I MG7iw i� m m o o m w�+rt•"
r
{ FILTER STA RITE 300 'SQ FT
.141-611__— 4'-6, 9' Ict,.. ■ NOTE: ALL "DECK t GPM
— Y i BY CENTEX HOMES HEATER LAAR SIZE 400 BT
=--- TURNOVER - 2 HRS
r +
lT 4 I N LIN 2 "
• Y` •• RETURN LINES
2
31611 KIMMER M0DE AMERICAN
l.CHE
GASLINE BY - SDCS FT -100
POOL. LIGHT 400 CLOCK T104R
`- ❑ TLJ _ ■ _ - 250,-
^ - !
ELECTRICAL W. SDC'
A RE -INSPECTION - - AUTO CL ^r'�P
y ;; FE`. - ---
.y -4 > - n HE . inmmm
" , Vi�ILL-BE CHARGED IF THL" ';;... PLASTER COLOR WHITE
SUNKEN BBQ BY y� 15t.3" ,.
CENTEX HOMES' y I 9'-3" PLANS AND 10B CARD Ak:.. '.. DECK' Wm s v A s mjQ!p •• m
THE SITE '.FOR A SCHe DECK 7�"
smaaW=
INSPECTION, ST p Fr
— - :NO EXCEPTIONS!- SPA SPECS..
SIZE 7 RAISED
DESIGNER YES+24" i
LITE 10 WATTS"
- - PFA 40',0" --_ '- C U i �1TA RANDY/EV RI LEVEL SEATS 22" 24" 27" ;
CITY OF i
6f-ORESIDE CE DATEDAMWALL " X - 'FT. CROSS
BUILDING .&
DEPT. DAMWALL TOP DETAIL "
9-22-99
^ p o\ / E D SPILLWAY SIZE DETAIL WIDE
w I A f 1 v REVISED PILLWA EN ED
•
PLAN.3 } FOR CONSTRUCTION #JETS 4 UPER". LOWER
LOT' 3 3 - BY. Name: CENTEX HOMES - t
DATE.
i Q Address: 80-418 SPANISH'BAY ' i
C�.1-A QUINTA
® r TRACT
EQ WILLBE
y = SET 35'
PALM :DESERT TEMEC�JLA�
O N 73-01 I'COUNTRY 28910 RANCHO
;'' _ • ��_,.� CLUt'3 DR. STE F-4 CALIFORNIA'.RD.
009fSoll
Polo/s
_1/8 —1 -SCALE 'PALM DESERT'CA:" -STE 206- _
OTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA'.
' 92590
ARE SHOWN FOR ILLUSTRATION ,X760) 346-4032 (909)676 -SWIM
ONLY AND ARE NOT INCLUDED.
LIC # A-974127