0301-147 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am jjcense i,uncler 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
656128 C53 HIC %6 �01 1 A
Date Signature of Contractor' 4_
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.
he
( ;). I,have and will maintain workers' compensation insurance, as required,
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 O'TATS C:OMPERSAV Policy No. 046-61-68-20'
(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 forthwit comply with ttto a psrovision&
Date:. Applicant-•�
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.
l.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 this City to enter upon
the above-mentioned property4bor inspection purposes.
Signature (Owner/Agent�� 7+"%°�` Da e'''
J--- -BUILDING PERMIT PERMIT#
-
j
DATE j VALUATION LOT TRACT
` f
JOB SITE1
��
ADDRESS ' f� !AzaCsu.IIIIMO E jDR
APN
..
OWNER
CONTRACTOR/DESIGNER/EN INEER
. SHBROEsK L? _,3,0P1VM4T COMPANY
C'fil..?�itANT.A POt3LS & PAS- Cf OP MAN PQM
51455 AVFM.A.l' 4, INAS
86-100 �5.'S+'EMPS 5
PCA 92OU
�,:. kx,
CA 92236
(760):,98-922-L
oo,355
USE OF PERMIT
.P00L.t'WDXAP,� € RA
POf;Ld;3F 291.4 4'r :i S 1: TtrAl.L9 CITY SiT.A1J,°?.f;.IM
ALU,I1+�•"•jl11ARIUKIL9 aMLL BE IN PLACE AT NUI -PLASTER fNSPr i'.'j! ION
3 F', WAU1 2E V
POOL AWtL DIOR SPA 1';459.00 1,.3
r
PLA14 CHRCK FED 101-000-4.39-318 $128,70
CX:NSTRUCTICd1d,Fa 101 -06.0-419-000$1i9ryg8.60
$24100Q00
Ey4 �\.4.f.7.f^al'1$9n'f. pImp. .. P00,10 101-00.0-421-�liy00 100r
ELECTRXAL FEE,- POOt'. 101=000-420-000 $45.00
Ir,P:t,�7:0!�� ING IR.F -- POOL 10'1 ��00-419-000 $2� t5dk
•
rJAN3 2003,
LA QUINTA
FINANCE DEPT.
. BUD40TALt"�xS 1`F .Iat '�Ii' x' X41
�re �jg;�pp''yy9��.
y? YyP�L�.N
r y�q�
♦.z, a.- - t!i3#7O K'.�iL' - L73A.L.< .i'�i o 8
�y1ry1
$0.00
TOTAL 1~'ERKt1(' FEES DU NOW
14,
4$422.,70
RECEIPT
DATE
BY `
DATE F IN
CTOR
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
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 T
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)
0
a
r'L up'l <c 7r
"TACE A-, -A Cr POOL, r.t.4
PA SPEC FICATIONS Tk
SIM �— X � SO. FT. <
SPA DAM WALL v0l"yr4
NO. Or JETS t rLE Tply
LST % q.'AR--"R R'3j'47,
'} -
12
FA --XD SPA AT
SPECIAL NOTES
V-,
sa C
EXCAVATION STEEL En
TYPE
0
ACCESS FROM MAN;^,N JOf4TS
U,
CANr'LE\CQ
ELEVATION
DEEP END RAMP DECK DPAiNS
LO)wr- SEAT DECCO DRAIN
CONCRETE REMOVAL LOADS CLA113 CURE
SOD REMOVAL LOAZS STEPS
TREE REMOVAL BY STr--- FA:[
0M.^ATION RE40YAL B TILE BASE - %� / i
PF"IATION REPAIR
SA4C, ANO, V CJrr _ "N
6' R.B.B.
12' R.S.B.
tp-'
24" R.8-9.
W R.8,8.
TAN SHELF DEPTH
ROCK P MASONRY
COPING TYPE
CENTERS
R,8.8. FAC!NG
SPILLWAY TYPE
PLUMBING
FILTER C ^L--1 f r F .St4 PR'�P. EXT. WALLS
POOL PuPUMPr.^ 'tf. ZE VE PLANTER wAu
goosin pimpo SZE RETAINt"el WALLS
ADDI PUMP SZE EQUM. WALLS
ADO*L mwSIZE FREPIT
NEATER SIZE or C1^t' T
TTM- CL"
SM PANEL
AODIL OUTLETS---
SKMER "r i -"^ L
ML UNE PEBBLE /PLASTER
GAS LINE STUBS UCRTS POOL
"TAIRS/SPRA*tADS LIGHTS SPA
R011D "D BEAM
SHEER DE5CEN S BEHNO SPA i-1 7 - i' - Li -1 I
EYEBALLS
MTS oN POOL( I) IN SPA 2 5- ('--
STLIS SET MMENT FENCING
WISC.
PLUMSM SIZE TT77 I- FENCE TYPE
HEIGHT
GATE
GUNITE GATE REVERSAL Cl
DEEP ENO RAMP REMOVE & 11004f,
EXTENDED 2M STEP
LOVESEAT
vuwAy rr-E
EST. START
CANTILEVER EST.
CONKIErna"
3JPHUG II L1 tt
VIMLM
R.S.B. - SEE STEEL
OWNER RESPONSIBILITIES
OWNER M- (1) TETERMW THE APPROXIMATE CLUATION OF POOL OR SPA At LAY" ON DAY OF EXCAVATION
(2) TAKE NOTICE THAT POOL AND EWPIFENT LOCATIONS ARE SUB ECT M ACCEPTANCE or I
LOCAL BUILDING DEPARTMENT AT IW Or ISSUANCE or PERMIT
0) WET DOwi CONCRETE SHELL AT WAST TWICE DAILY FOR SEVEN DAYS AFTER SHELL IS INSTALLED
(4) AMEE THAT CALMNIA POOLS IS NOT RESPONSIBLE FOR UNDOZOPaM CONDITIONS OR OBJECTS,
AND ANY DAMAGE TO CURBS, SZOEWAWS; MtWAYS, LAWNS, OR OTHER MS IN THE AC= APER
(5) SEE THAT ALL FENCING, CATO, AND CARACE DOORS MEET LOCAL CODES TOR A POOL ENCLOSIAt
PRIOR TO PFMASTER INSPECTION C5
(6) FILL POOL'NVMATrLY gin PLASTER. (FOLLOW INSTRUCTIONS -- DO NOT m ftuew'-A POSE)
(7) TAKE NOTICE THAT THIS DRAV4C IS THE SOLE PROPERTY OF CALIFORNIA POOLS AND THAT ANY
USE WITHOUT WTTEN POhMON OF CALJFMVA POOLS, INC, IS PROHIBITED By TAW.
OWNER APPROVES PLAN. POOL. AND fWpUENT LOCATIONS AND HAS READ TWE 0,r
ft - TIES ANb NOTICES Aeow-
SIGNATURE(S) DAV
SWIMMING POOL PLAN EOR:
NAME
RAYCRAFT RESIDENCE
STREETa =t''
JOB ADDRESS
PHONE OFFICE RES
LOT. l TRACT PAGE BOOK
MAP BOOK PAGE NO.
ACITY
MAIL ADDRESS
CONSTRUCTION OFFICE PHONE NO.
SCALE DATE DRAWN BY SOLD BY CHECKED
7. _Y
Ly
JOB#
REVISIONS DATE