0209-033 (RPL)LICENSED CONTRACTOR DECLARATION
r 'cJ 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
N W _Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date-
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•� r� D 28 ' CS.x &:E�t�` 1 fiJ:t 110:
12LER Signature of Contractor --/"I.
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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
( )`'-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.
(!,/) 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:.
Carver STATF COMPENSATI Policy No. 046000 168-01
(This section need not be completed if the permit valuation is for $100.06 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 3 00 of the Labor
Code, I shall forthwith comply with those provisions.
Date:/.=p f- Applicant Z.
t
A.: ,
Warning: Failure to secure Workers' Compensat on coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person'upon whose behalf this application is made &:each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of.issuance•of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
j
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Signature (Owner/Agent) - 1 Date 12"-
' PERMIT#
-�' BUILDING PERMIT
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LOT TRACT
DATE " �f1 _: V�LUATIOND
l�I(
..)' y
JOB SITE ?
ADDRESS 7.57:5 MENM LE DME
APN
OWNER
CONTRACTOR DESIGNER ENIINEER
motnox yyrmaima p i
VAvpRW1POOSWA
bW-A3' (TI OrMAR C( i
514 0AV:6'N"1DA MCVAS
86.100 AVENUE 5:4
CARLSBz4D C.A. 92008
COACHUA
P!�►, !�2Z3£r
' (760)498-4)222
(MIA' ODS55
USE OF PERMIT
�+00L Am' .10R A9,
MaJl,/Sii A.. Al—A NISIDARRIERS SHALL 8E DSS P1.ACID AT PRYE-PR ASTER
r9OPk C"! ION. V.Q'%Ilr�.MPNT PNCFk$£.fRK WOT )..1NCLUl Er)
�VALUATION 17,500.00 LS
E.K]`lih+XFTKD MST OF CONS"' NUC'Y1C.'Pi'
1715W.00
FM strMiURY
PLAN CMIX FFZ 101-M-439.318 $122,35
Ct N.TrRt;CTION FEE 101-000.410,, .000 $1 ".00
91^..CI1ANIC'A1l FEE -- POOL 101-000.4.2'1-00o 924.00
ELL C; AICAL IMF Au POOL 101-000420-000 '45,0'0
PLCIMBIA0 FEF -- POOL 101-WO.410-000
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RECEIPT
DATE
BY
DAT I AL
IN"T
M
•',7
s'i
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
i
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs
I Electric Bond
Footings
I Main Drain
Bond Beam
Approval to Cover
Equipment Location
,�..
Underground Electric
Underground Plbg. Test
1Final
Gas Piping -M
PLUMBING APPROVALS
Gas Test v 1 b I
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
- u
COMMENTS: �✓
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lau Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND 10B CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
T•
SPECIFICATIONS
IT TrrE _ vG►V►J iT>,_ SIZE Zg'-o'�
x44
� .r
SURFACE AREA OF POOL d
I'!f[rMEreR g� DErn+s Td1N 3� Q" -mm.
4
� v v i. 1►/ i .�. � v v .+, i v a 7 J. i t/ i .s, i v i ti IJi i i. i \J i\ �
SPA SPECIFICATIONS
SIZE x __q_ Sm rt.
SALES
FIELD
DIG
NO. OF im
TILE TRIM
PRE-GUNITE
Rouen
VA15M SPA AT
UNDERGROUND
SPKI.VIAY TYPE
MASONARY
DECKING
Sa Fr
DECK
EXCAVATION / STEEL
PRE -PEBBLE
PMI
-
SPA SPECIFICATIONS
SIZE x __q_ Sm rt.
TILE
TILE flit
SPA DAM K&L MV
PATER Lm
NO. OF im
TILE TRIM
MOTCJIARTER
Rouen
VA15M SPA AT
SPKI.VIAY TYPE
Saw& NOTM
DECKING
Sa Fr
EXCAVATION / STEEL
TYPE
PMI
Acne" PROM `
EeANslc+i JO"
ELlNAnON
CANTTLMR
Derr END RAM!
VWK DRAM
LOVE SZAT
Oft" DRAIN..._
CONCRETE REMOVAL LOAM
0" CORE
900 REMOVAL LOADS
STM3
TRS REMIOVAL vy
STEP PAG!
Wt OATIM REMOV
TILE FDIC
0"*AnON REPAIR
SAM AM67 1/162JEZN
b' RDD.
RIEBOPlS
L7 RDD.
P
w RDD.
24• RDD ft
SO' RDD
TAN SMQ.("
MASONRY -
Rouc
CoPNb TYPE
G£NTLItS
RDD. PACMO "
SPIuj%Y TYPt SfZE
-sTtrs .
PLUMB I NG
PLTER btu
HNtOP. EXT. rw i5
POOL PLMP 912E
PLANTER Vv"
EIOOSTER PIJIA' SIM
ADDL MW SIZE
RETAMNO 1 %.LS
EU IR. MALLS
PptlnT
ADM PV" SIRE
NEATER SIZE
TIME CLOCK '
� rArHa.
ADDL
OK144M TYPE
PILL LIM
PEBBLE/PLA5TER
sAs 1jw snee
ue+rr' Pool
LIOWS SPA
POIJJfTAMSPRAYWADS
Fjou" Dow SEAM
EEMND 60A
.
tYtDALLs
L*" M POOL IN SPA
FENCING
STLD SET Ewm."T
1. .
Hoc.
PL"" SIZE
M ce TYPE
"law
BATE +
GUN I TE
OATt REva�v�L
DEEP END RAMP
REMOVE 1 REHAft
EXTENDED Ind STEP
L.OVEEUT
PST. START
SMU J%AY
CANnLEV4t -
WPM �
RDD.. SEE STEEL
OTHER
ONNER RESPONS151LITIES
O"CR TO, N OETM"W TIE APPROIQMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY OF EXCAVATION
(7) TIKE NOTXt THAT POOL AND EUlIPMENT LOCATIONS ARE WSZCT TO ACCEPTANCE OF
LOCAL DUILDIN6 DEPAR"Wr AT TIME OF ISSUANCE OP PERMIT
(31 VCT DOM CONCRZTE W -ML AT LEAST TW_Z DAILY FOR SEVEN DAYS ALTER SHELL IS METALLED
(4) A6REE THAT CALIPOMA POOLS q NOT MPONSICLE POR oVeR6ROum CONDITIONS OR Caj!CTS.
AND ANY DAMAGE TO CIJRCS, SHVMV4", OMMDUYS, L v". OR OTHER IT" N THE ACCCSS APMA
H'3) SM THAT ALL PENCINS, BATES. AND OAAW DOORS FRET LOCAL. CODE'S FOR A POOL VCL OSI t
FLUOR TO PREPIdLSTER myowTION
(6) FILL FOOL ""MATELY APTM PLASTER ftLLOM RCSMC ;M -- DO NOT USE RLbDER NOwj
(T) TAKE TV= THAT THIS DRAY11HO TS THE SOLE PRGFZRTY OF CAWPOP"A POOLS Alm THAT ANY
USE Mr,4a T YRITTFH PERM "ON OF CALIPORMA POOLS, INC. h PROHIBITED EY LAW.
OI'!CR APPROVES P.AK POOL. AND ZaAMENT LOCATIONS ^0 HAS READ TWE Rr5PONSDiLME5 AND NOTICES ADOVE
SI64ATURE(S) DATE
t _ SWIMMING POOL PLAN FOR:
NAME HOCKETTLLEHR RESIDENCE
SIRE T 57- 5?5 Etitr�iot. ,J
JOB ADDRESS t-,Sm,�e)t, ICITY k^ C,i jwrA
PHONE OFFICE 5 RES
LOT -Z TRACT PAGE BOO
MAP BOOK PAGE NO. ICITY
MAIL ADDRESS
CONSTRUCTION OFFICE PHONE NO.
SCALE
DATE
DRAWN BY
SOLD BY
BY
LY
]CHECKED
16PA+i
REVISIONS DATE
1
2
3
4
5
SELECTIONS
STONE
TILE
BOULDERS
DECK COLOR
JANDY
PEBB./PLAS
Wr1fTt.nT'J�HQ
SIGNATURE
0
W
-w
A
w
W
W
DRAINAGE NOTE: Drainage and irrigation for planters and pots, by
others, unless otherwise noted.