0205-013 (RPL)t '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
C53 HIC CIA.
Date Signature of Contractor 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:
( ) 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.
-( ) •. I have and will maintain workers' compensation insurance, as required by
Z._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 ..AIN i� ��ATI Policy No. € 61Ee"I
(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' compensationy�rovisions of Section 3700 of the Labor
Co'd�,l shall fo, hwith comply with thoselprovi ions. /r
Date: ' Applicant r t
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.
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 afu 4orize representatives of this City to enter upon
the above-mentioned property, for inspection pur oses.
Signature (Owner/Agent)y= + DO�
BU� C I G PERMIT PERMIT#
�•
DATE VALUATIONLOT TRACT
JOB SITE
ADDRESS 57-Q!5 ,r �Tlrl i D
APN
-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
A 3��Bi�kt?K A�l.r
C..MPOMIA.P001.8 & SPAR {'1't`:) ?A6AN iii :
5149.e1kVM1DA ENCAW
74725 -�JONI VRI v ,t MA"a '#A
CARLSBAD CA 92008
PALM, DESERT CA 9'WD
(760X-40-9900 CIBLO W355
USE OF PERMIT
SSPA,�y��1;1'.,"M"ARMRS SKAU., BA rN P1 ACR AT PIdtE.A 9'.rF11
'Py€�M�}`y
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llbv ei .t'A,..F 9�r� A47 Y.«4!��p 1L M,dts��h.�'�T�nlLVi��`�b 8.4fk4',6�1
ro Lp:2 a�42�
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6'fmY'1 u(MONP 101-000-41"00 .Oi)
2JO€'iEt2MAL M -o F0.11 ix. 101- -421-ODO
=CTIR C°A3,M--PWDL 111000.4213.000 S'45;00
PLM4WIG PER P001,
'ICICITYOFLAQUI
=14
813.8-TOTAL WNSTAUCTION AND PLAN CHWIC
"37.55
LESS PRE -RAW OWN
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F
'IV'TAS t PMCMMNS MW NOW
X437.55 .
s
RECEIPT
DATE
BY
D I / Q1K
SPECT
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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
_
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
1
Underground Plbg. Test
•7
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
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)
Finalahv/:
COMMENTS:
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00CR TO. b) OEM" Tit APPROXIMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY p' EXCAVATION
(2) TAKE NOTICE THAT POOL AHD EOL'IPh W LOCATIONS ARE W&JE.CT TO ACGE°TANCE OF 0
LOCAL DUILD1Ne DEPARTMENT AT TIME OF ISSUANCE OF PERMIT
(S) MIT POM CONCRETE V-tLL AT LEAST TYWX ONLY FOR SEVEN DAYS AFTER SHELL F! INSTALLED
(4) A60EE TMAT CALIFORdlA POOLS h NOT 10!"4518LE FOR 04PERR6 Ol" CONDITIONS OR OC ECTS.
AND ANY DAMAGE TO CURDS.'.SIDEKAL", DRIVEAAYS. LAMS. OR OTHER IT" M THE ACGe" AREA
(S) SIE THAT ALL PENG46, GATES. AND 6ARAde DOORS MEET LOCAL CODES FOR A POOL EHCLOSIRE
PRIOR To PREPL.ASTER *ePECTION
(e) FILL POOL. IMhEDIATELY AFTER "TER. 1POULO►'i MISTRJCTIOM — DO NOT VSE newt HOWJ
h) TAKE NOTICE THAT TMS ORAWN6 IS THE SOLI PROPERTY OF CALIFORNA POOLS APO THAT ANY
VSE MIT'ik)UT OMMEN FEWMWN OF CALIFORNIA POOLS, M. 15 PROHIVTED BY LAM
OMfER AM'ROVES FLAN, FOOL. AND EQUIPMENT LOCATIOM NO HAS READ TIE RESPOWtILmp AND NOTICE'S A OVE
5l6K Tag) DATE
SWIMMING POOL PLAN FOR:
NAME t.7 1�I: J.�E� I�ESIDE��i. CE
5PECIFICATION5
o �
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Wi=t
STREE•-oma
TYPE -r cly e r`
size, X 1-
LOT tiq TRACT PAGE BOOK
SURFACE AREA OF POOL
MAIL ADDRESS
011" MIH, MAX.
SCALE
/8"='*
PERJMETl7� (SGS
DRAWN BY
5PAECIF)CATION5
SIZE x --IL SO• FT.
SPA DAM r(A.L wDTH S"CZ
TILE
TILL TYPE
rrAtot LM= `�'
REVISIONS DATE
NO. OF JETS
L16RT
+
RAISED SPA AT % L
smu-0IAY TYPE
TILL TRIM
QUARTER ROUND r+"'
RDD. TLE
2
3
BUILDING & SAFETY DEPT- I
������ PLANS AND J CARD AR
THE
FOR CONSTRUCTION INSPECTION.
SPECIAL NOTES �+►.
1 EFIl M!5
NO
�, � �L BY ��
DECKING
'Q
fIMSM � F Clta�
EXPANSION JON"
F
SELECTIONS
EXCAVATION
TY2 N � L t {
ACCESS F+tON �"j�- 'I•�i
\+,'f.CA
PEBB./PLAS
+�.
ELEVATION' i �LTiQ
DED' END RAMP
LAVE SEAT 'i
CANTILEVER
DECK DRAINS
PEC40 DRAIN
CONCRETE REMOVAL
CURD CORE
SOD R1547VAL `� LOADS
512" -..�
TREE REMOVAL RSY
STEP FACE
M*ATION REhGV �
IRRI6ATION REPAIR '^
TILE DASE
SAW AW YtSQ1EEH �C s"= �•�
L
b' RDD. `
RemotS
it RDD.
MR STRIP •'
24, RDD ,....,
30' RDD � R
TAN SHELF
.....
MA50NRY
ROCK M20cm
GO!'IN6 TYPE
ceNTERs -�-i—
RDD.FACM6 F
SPILLI'LAY TYPE S �- � E- C- gid
PROP. EXT. Po"S
PLANTER MLALL
RETAIMN& FOU -S '�•-
PLUMBING
FILTER } SIZE L� v
POLL PUMP SIZF 2
,-
DOOSTER PUMP y of=EGllIP.
P' M' ♦.I FTv-.
AD LSIZE
FR""
ADOt PUMP ""`S11E �
% ,L+`lC 'k+ � f e I
RATER S ,'Aif A,(; � 9"mL} .I t`i`ff'
9Ud PANEL.
` x
ADDL — -
SKm4mm TYPE URAL �i
FILL LINE���
&*s um � � � � � Snes """'
PEBBLE1P14 I ' Gp
L � POOL
rOL�TrAix�'SPRAntADs '�
Rum DOiO eeAM •""•
s"
EESM SPA
SHE'Pft a
L.*" IN POOL_L= �IN SPA
!'fESAt1S '�% �t.'�
Sxeser 1!0 4w `
FENGIN&
Pupenas SIZE
2- - LAP Li l W
".rr
eATe
GUN I TE
BATE
DERr END RAMP
ExTrow 2.4 STEP=
1
L.OVeWAT
SPU MAY I�""
^
EST. START
. .
c'Atryr ....
eST. Cl*"_Erm
'
GOPNS
OTH>=R N A-r-� �arrr Sys
RDD. - SEE STEEL
OW R PONSIBILITIES
�i
! Q
in
s L 9
! O s
� J
�a<
0
00CR TO. b) OEM" Tit APPROXIMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY p' EXCAVATION
(2) TAKE NOTICE THAT POOL AHD EOL'IPh W LOCATIONS ARE W&JE.CT TO ACGE°TANCE OF 0
LOCAL DUILD1Ne DEPARTMENT AT TIME OF ISSUANCE OF PERMIT
(S) MIT POM CONCRETE V-tLL AT LEAST TYWX ONLY FOR SEVEN DAYS AFTER SHELL F! INSTALLED
(4) A60EE TMAT CALIFORdlA POOLS h NOT 10!"4518LE FOR 04PERR6 Ol" CONDITIONS OR OC ECTS.
AND ANY DAMAGE TO CURDS.'.SIDEKAL", DRIVEAAYS. LAMS. OR OTHER IT" M THE ACGe" AREA
(S) SIE THAT ALL PENG46, GATES. AND 6ARAde DOORS MEET LOCAL CODES FOR A POOL EHCLOSIRE
PRIOR To PREPL.ASTER *ePECTION
(e) FILL POOL. IMhEDIATELY AFTER "TER. 1POULO►'i MISTRJCTIOM — DO NOT VSE newt HOWJ
h) TAKE NOTICE THAT TMS ORAWN6 IS THE SOLI PROPERTY OF CALIFORNA POOLS APO THAT ANY
VSE MIT'ik)UT OMMEN FEWMWN OF CALIFORNIA POOLS, M. 15 PROHIVTED BY LAM
OMfER AM'ROVES FLAN, FOOL. AND EQUIPMENT LOCATIOM NO HAS READ TIE RESPOWtILmp AND NOTICE'S A OVE
5l6K Tag) DATE
SWIMMING POOL PLAN FOR:
NAME t.7 1�I: J.�E� I�ESIDE��i. CE
0 ROVED
OT ON
DULED
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STREE•-oma
JOB ADDRESS A L>67 8 A TC-ITY L-.
PHONE OFFICE RES
LOT tiq TRACT PAGE BOOK
MAP BOOK PAGE NO. CITY
MAIL ADDRESS
CONSTRUCTION OFFICE PHONE NO.
SCALE
/8"='*
DATE
-2- a -
DRAWN BY
SOLD BY
KC; I V','
CHECKED
REVISIONS DATE
1CITY
OF LA QUINTA A RE-INSPE FION FEE
2
3
BUILDING & SAFETY DEPT- I
������ PLANS AND J CARD AR
THE
FOR CONSTRUCTION INSPECTION.
4
1 EFIl M!5
NO
�, � �L BY ��
A,
UNDERGROUND
SELECTIONS
CONSTRUCTION
AUTHORIZATION
STONE,��
TILE
SALES
FIE -LD
BOULDERS
DIG
DECK COLOR
PRI:-GUNITE
JANDY
A,
UNDERGROUND
PEBB./PLAS
MASONARY
SIGNATURE
DECK
PRE-PEI3RLE DRAINAGE NOTE: Drainage and irrigation for planters and pots, by
others, unless otherwise noted.
l - 77 77=7 fill=