0403-342 (RPL)3 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
656128 C53 MCaatr ,13
Date _ ' ftp Signature of Contractor F 'b •17.� L!
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
() 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.
. Q 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:
Carrier I Policy No.
STATE COMPENSV1 04-6169-2004
(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 forthwith comply with those provisions y fi
Date: "'� '� + Applicant �. r �� a �1
Warning: Failure to secure WorkersCompensation 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.
f•.
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 propeZZ
tfdr inspection purposes. -y
Signature (Owner/Agent) -✓ �s Date 0, �. f
BUILDING PERMIT PERMIT#
DATE ° } VALUATION ~ LOT 0403-342 TRACT
JOB SITE
APN
ADDRESS sa'-"7,95 g57JpacVmg's
'" -•
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ASEMIZOOK DE (►E',IsCi%MW T COMPANY
CfiJ,1-ORI ti.A POOLS & SPAS ('T0P MAN X-01
5140 A`,T1rMA ERIC,1113
86"100 AVWJE 54,
C. M-19BAD (11 A 92008
i".O.ERCHE? EA CA 92236
(?60)398-8221 MIX 00355
USE OF PERMIT
x OOL A—IT—WOR 9PA.
a "
POOL @: SPA .UR(J V481 Z21.5F-1995.. A.LAP.MSMARRIERS SHALL ap,
IN PLACE PRIOR 'i O PREPLAS ER INSP F,01'1014�
POOL ANDJO SPA V3ei)MW LS
PE 1T FEF 4J17:'V1:PI1 RY
PLMI CHTECE FLEE 101-000-439.318 $.122,05
CONSTRUCTION �'E 101-000-118-000 $189.00
MECHMUCr L' FEE -- POOL. 101-000-421-000 $24,00
SLIXTRICRii. FIC -- POOL i 0l -000-4.211 000 $43.t?0
1'LtiM51NG FEE Pool, 101-000.4.19.000 $27.00
8UB-TOTAL C 0149 TR.1i"MON AND FLW, t,'MCK
PRZ;PAW M
WOO
OTA1r, .P�'" fr MtS DUVENOW
V407,'S5
"rINLMS
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
W.
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
4
Underground Electric
Underground Plbg. Test
Final
Gas Piping
r 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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
I,
i
RT�R MATURE w T 3
a
SPECIFICATIONS
uu �U �ER
1
11
��
_
{
I r 7-'
`l U T'G
rr r r
`1
TYPE r� I
_
SIZE 3 X Z 5
LLO
IW �,
I � Y S
6
UR Fl .
SURFACE AREA OF POOL
U -)S
r
�._
d
DEPTHSPERIMETER MIN.� MAX.
MN
o0I
.I
�f
�1.
SPA SPECIFICATIONS S
TILE
i
_
r_
,�•,__
SIZE 7 1
.� X SQ. FL
TILE TYPE
a .,
U o
�
1
SPA DAM WALL WIDTH
\'
N 0. OF JETS
WATER LINE
aI�
v
n
..
..I
� R.VC�
/,
l.- /, [p? L�
Q �V t\
—
sem'.- ��
LIGHT _�
TILE TRIM
E
QUARTER ROUND .�'
J
w
S a
N
N
co
v
__- __. _ _
/
CCNCk
RAISED SPA A f "r
R.B.B.
a
cp
I 1
_ �
r�._..-
3
�... �
SPILLWAY TYPE . G k.-
SPECT AL NOTES r ,-
y^-`+
w .
U
N
�f N
o
l
.
N
w
w
Z
w
DECKING t.
4
3
SO. FT. l( -
FINISH r
MI
a �
OTYPE
-
UEXCAVATI
J
_ r
0 0
coU
a
\
EXPANSION JOINTS
ACCESS FROM
a
F
PA ATtis I
ELEVATION
4 c"
ANTILEVERAISGbS � �
0�
:
t
5 MV OTN
CC7N G �
CAF A
DEEP END RAMP
-
LOVE SEAT
DECK DRAINS
DECCO DRAIN
T t�Gr
_
\ �
� �
��R
5 ,LvAa
..
CONCRETE REMOVAL
CURB CORELOADS
._..
MTA(-?F POCZZCa
SOD REMOVAL
TREE REMOVAL BY
STEPS
STEP FACE
i
I : c� N� �AR Cv
IRRIGATION REMOVAL
TILE BASE� ----•
.�-
VCK
Ir �
}�co
ll
/a
IRRIGATION REPAIR ----"'"
6 R.B.B.
-
SAND AND VISOUEEN �...�
dd
V
RIBBONS
`J
t'1
12" R.B.B.ft
18. R.B.B.
ft
MOW STRIP
24 R.B.B.
I
30" R.B.B.ft
t
TAN SHELF D EPTH
MASONRY
-- -
ROCK POCKETS
:
CEN R �"'..
TES
COPING E _
N TYPE
_
R .B.B. FACING t
i
l 1
:i
.SPILLWAY TYPE SIZE
;I
—
STEPS
PLUM
PLUMBING
I I I
f
FILTER Ctkt,r SIZE � , . c, PROP. EXT. WALLS I
I�
POOL PUMP �.•� SIZE • � �`
PLANTER WALL
- -RETAINING WALLS
..fir i '""_•'"
BOOSTER PUMP i.r r F
o 7
SIZE - -..
EQUIP. WALLS
\ .----
- •- \/ ./ ADD L PUMP .SIZE
FIREPIT �---
_ ADD'L PUMP SIZE
C L�s0
e
HEATER
- 51ZE myi
u
sP�CT �nr •
ION F
OF 2 �
„
W n �� C3.F
LA QU9
P
Vt Iiia
&S
S A DEPT.
3 tvn�og
CARD A TffLE 011t,
_. RE NOT .
A
..
SCHEDULED � �
ULE tits
D
• t�C
Ti
, 4 .r �
NSPECTIO
N , Tqp'�4 EX CEPO
TI
`J ON
S.
_ ..,
I I2E-I BBBLI: f uramc e and. irrigation for
DRAINAGE NOTE. g 9 planters and pots, by
[�
�I
others, unless otherwise noted