0011-213 (RPL)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. Date
/673
e-. Signature of.Contracto. �!
' 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&RC. 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.. ,
'yYf I have and will maintain workers' compensation 3 insurance, as required by
Sectlion 3700 of the Labor"Code, for the. performance of the work for which this
permit is issued. M' wor'kers' cornpensation insurance carrier & policy no,: are:
Carrier Policy No.
STATZ FUM - -g ,jaC+t93`a
(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; ar�d agree that if I should become
subject to the workers' compensation;pro�vlsion�s of Section 3780 of the Labor
Code, I ally orthyulth comply wi h'thoseprovl, loins ^ -,
p to C! Applicant j " ,.
Warning;. Failure to secure Workers' Compensation cove ge 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 regUest.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'thisXity to. enter upon
the6bove-mentioned-property for 1nspecAn purpoT es'` t p
Ignature (Owner/Agent) }1' i�_ 3t ,p Date4✓/�
BUILDING PERMIT = PERMIT/!
DATE VALUATION LOTTRACT
JOB SITE
APN
.ADDRESS
A 80-517 10,*AWNW, BAY
OWNER. -'
CONTRACTOR/DESIGNER/ENGINEER
Carl=1 W&W
ML HArt..�;°LOX d'ba, VACA110M POOLS
�%�3C? `S�F14R'►::j�.�.�� Z''��C'P:.��; �i7".I'.�"t"l 50
t.3���•.1J�1�;+3:"►k�C�A7 �,�.
+C<?RMA C:A. 9] 20
Luma7mAi.I'sn, '. C.A 99356
(7.60)218-6045 c=At 4335 .
USE OF PERMIT
'A AAF6.#,L ly3W,.
C'y3iY
�Ap];t.(j:[At.a°N.��*�:'f'\t�WHA:.ItAIi;;7I•i'. q:�P.P p{'T'j:.yA,C1yE�9AT
jP��i77���)(�...91{7,(;��fj[�l��
TRl:.',lrL�r7 d�P!7.4. �9'l p7J-.U•Q.j l.j�,✓8�7a .R/b+td Sn�.�lll�V(J �C:jYYA ,~.nI'4 QT,,.frM�atA d�II. ,?.�.CVf�I - .
MOI,..U'1:,tE0 rN THIS P'Y&WIT.
POOLANDIOR SPA 1*9
i�v3��FMH/.v.A.XMv wrW/�TJrair 'L��JA'1 .6 A8:1 `fir on1510=09
PLAN C1Ium "'.4I• I'm.,,000-439.316
CONSTRUCTION !� F, -.161-000-418-400
MECHANICAL IC"..AL FRS: •- POOL 101.000.421-000
2UXCTP.IrA,4 P8r. .. POOL 1 f11 r{?artC? 20-Ot,O
•I
PLUMBFHO PILI ;: Pool,'. ' :..': l-WO-cx 9.000
OUR_I+ /.1:!^ I CC2i�'►'�1RITC" 701IT'AN 1 PLAM,Mu.;Cx
$363.30
LA,440 PT' X41 TWO'
$0.00
MOW 1111=0M
-RECEIPT
DATE
2 SSP%:
FINALED
INSPECTOR
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 Wali 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 PI . 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
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)
VACTION POOLS 619 248 2919 P.03
VACAxYQN POOY,S & SP,A.S ' ! ` : j'
9522 Donaldson Road
Lucerne Valley, CA 92356 .i
!ti_; �' t`
s; (760) 248-6045 '
's (760) 248-2919 FAX
t M- Lie. #0-53-351673
Sales Locations i
t' Rermuda'Dunes 'Irvine,.
'California City, Rialto,
>� ( Lucerne Valley
x 1 800 999-1811 t ;s
F IFIQENER ATT N
�S
AL
E I X moo'
�
DEPTH
�.. 3 p � METER
"y TILE CHOICE
SQ.
I ?:
RBB. !
COPING
S POOL CAPACITY GALS ::�` I'i
PUMP CAPACITY. GPM
MOTOR HP HP
MOTOR HP HP i
FILTER SO FT
a
I
FILTER RATE GPM
14
HEATER SIZE BTU
ti71
TURNOVER HRS
1
SUCTION LINES
RETURN LINES
r
,
SKIMMER'MODEL t/
ii�ir
`
CHECK VALVE
'
GASLINE BY VP FT.'
POOL LIGHT Ye,5 CLOCK a-�
ELECTRICAL BY V P FT. ! I
AUTO CLEANER
CHEM. FEEDER
PLASTER COLOR 1^ i ; r •! ' r
iii,:€
V:
� �� E'.
DECK 8Yv� SQ st
--• _._
pECK TYPE c�.a -�i `
j I o Q
STEP FT.
;K1 SPECS.
SIZE 7'x 7' RAISED /-,1'/
vV
E e-� WATTS 0C
AL LEVELSEATSMWALLMWALL
N
TOP Tij e
SPILLWAY SIZE to" X /,,1." WIDE
DATE
SPILLWAY 6
CONTRACTOR cannot assume responsibility for
#JETS 1
yi:
I`
- damage to cubs, sidewalks, driveways, cement
slabs, sewers, lawns, trees, fences, retaining walls,
sprinklers, telephone lines or shrubs. Name:
When access is made through a neighbor's property
P>� N
it is understood that you, the owner, have that Address:
S O S �.
15A Y
neighbor's permission and assume full responsibility,
TRACT LOTS
DATE R
'�cirwNaTt IRF.
n +
VACT I ONPOOLS 619 248 2919 P.
l r i i!
L
1 ..�G:�
+!tliV
1„i Ste. II{ ,+ - r•- .._^ ;--�^'.— i - i f j!•I i 7tt� P�
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i� ,y ����. -6�}1 "s~'� J a`' �.Iy �eY. t � .� �• ` 9 / // + ' �. t ., � � � it ¢slrtnl1.
e + ` a.'t�y }• `� ;•4�` 'i'.s �Y ) _ � t r ( � sl{ {tt�.I;`11�
�� i+ �3 _him ��13,'i�1; •211}3 }i}.4'X.y .[Ts ,. , .- ,. t •i 1 I �l 1}r �}
t{J!L?i Y L I .j •I .,{ � � _„ + t'' � -- fes. 4. 1 n I? L, iL,�
+ ,1i� I � ' i I s •�
, - i , { � : !1• i is
3' POOL 5 +f;�
111 .n 1 h
IN
G :r
° 4 CITY
I-
I
° Q ° . N QUJD,
RE-iNSPten0w. T�E OR ! & SAFETY
ErA ROVE
P NS ANO 108 CARD ARE NOT ON FOR CONSTRUCTT E S{TE FOR A SCNEOULEOPECTION.DATE
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