9712-080 (RPL)LICENSED CONTRACTOR DECLARATION
U) ` I ;iereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cv W Professionals Code, and my License is in full force and effect.
=) ch License # Lic. Class Exp. Date
I-- Q u7
i
r— LL ;Z
i j' T' r - —
A &3109
oZ � Date I( f�1Signature of ContractoI '
�0
J U C:) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 1, 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).
C'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
Q WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following. declarations:
Lo r < O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
CD Q L) ( ) I have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
0 rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
It Carrier Policy No.
O STATE 1'%tND 1742679-97
J (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
3 subject to the workers' compensationjo sprovisions of Section 3700.of the Labor
Code, I shall forthwith comply with those provisl.
Date: �• I'll Applicant • �,7`Y10 ", �
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 authorize representatives of this City to enter upon
the above-mentioned propefor inspection purposes.
j' 0, /l1
Signature (Own er/Agent),/ 2e Date.
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT .971UNO TRACT 6.489
S201%9.00
JOB SITE
APN
ADDRESS
54-31" SHOAL CREEK _
OWNER
CONTRACTOR/DESIGNER/ENGINEER
WILSON
STEVE DODSON CONSTRUCTION
54-366 SHOAL CREEK
73.011 COUNTRY CLUB `DRIVE, STC?. F4
Uk CIUINTf1. CA `32253
PALM DESERT CA 922M
(70)3,16-4032 CBL# 104:1
f
f
USE OF PERMIT
m t�
POOL AND SPA ONLY . PAUJ -
mr, 14 0 1997
PQOL AND/OR SPA, 20,969.00 LS CITY OF
LA 0U *14TA,
ESTIMATED t`,O&f OF CONST'[OW71ON
ZCl,9b�►.sNl
PERMIT TEE SUMMARY
PLAN CHFCK FEE 101-M-439-315 1140.40
C0NSTIRU010( IN FEE t.01-000418-000 S2) 16,00
NIECHANICAL M, — POOL 101-000-421-000 $24.00
ELECTRICAL 1FFE -- POOL '101-000-420-000 545.00
PLUMBfNG FT- E -- POOL 101 -000419 -Wo $27.00
SUB -WI XAL CONSTRUCTION .AND PLAN CHECK.
$452.40
LESS PRE -1 AID I,'EES
MW
TOTAL PERMff VEVS DUE NOW
$452.40
o ,, •+iii".
RECEIPT
DATEBYE`//
Q_ �- . 0 �1
r-. l�
DATE FINALED
INSPECTOR
. .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab 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
Gds Test A/O0
Electric Fina
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 — i
COMMENTS:
,01,0G 1.vS X4/1190 , /'/A�✓S
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Frdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
_ p/I
P/L
LANDSCAPE
AREA
C
FAIR WAY TO GOLF COURSE
spa raised at +18" harksiriF of rnnl raisgrl ar 12" 18" sheer descent
24" sheer descent
SETBACK AT 12" - entry steps
e
6'-0"
I
9'-10"
t
L
tile dam wally 51-101, -N
quartz. grey spillway .®
a 77 1 20'
surcharge pool
owner to provide gas run 1 112" stub out .
and electrical service run to this point
pool builder to install sub panel box
this location.
V
residence
STAIRSTER.YJATERFA_ LL
W /ROCKY MOUNTAIN QUARTZ
%VATERLINE & CAP FOR CASCADE
i{ :.4.
GENERAL SPECIFICATIONNS
yA fi tl E :................
TOP .... . '
::::;::SIL :::::::: :::::::'::::::::::
:::PA ::::::::::::::::::::::
:::. -�
::: C":A
..1....ER.:::::::::::::::::
...........................................
1 et in .
>':,':,.»::•:'>':,, :,.:',:.:,,';:'
»:: >: wall ....... .
AREA ` 295 PERIMETER 90'
::::::::::
18'' WIDE
:......:::
SPA DAM
...........
WALL
have that neighbor's permission.and.assume_full
RBB backside +1 2''
+is•'ug
-+I5"TOP OF Dail
NVAI_L
NVATEr:LINE
CONTRACTOR cannot assume r-esponsibility-.for
GENERAL SPECIFICATIONNS
damage to_curbs, sidewaIks,.driveways', cement
- - --- ---- -
slabs, .sewers, lawns,tr..e.es,. fences,. retaining
SIZE 11 X 28
walls,. sprinklers, telephone -lines or -shrubs.
AREA ` 295 PERIMETER 90'
When access-is.made through_a_neighbor's
DEPTH_ ---.__4'x 4112 'x 4'
property it is understood that ynir; the nwnPr,
TILC.CI.IOICE_.-group 3SL 70
have that neighbor's permission.and.assume_full
RBB backside +1 2''
responsibility'
COPING cantilever
DATE _____ signature
POOL CAPACITY 12 000 GALS
PUMPCAPACITY-. 103 GPM
- r _MOTOR HP _STA RITE _Hp1
MOTOR HP starite Hpl h.p.
- FILTER STA RITE 300 _ SQ FT
102 . GPM _...
HEATER__LAARS..___SIZE BTU .
TURN. --VER...---- - ----- --HRS._...
SUCTION LINES _-- ---- -._ . _2@1_.S
RETURN LINES.-.___-. _
SKIMMER MODEL american
C--- CK VALVE._.._.. Yes -..
GAS L E BY sdc FT. stu_ bout
QQ` \���Q POOL_LI T 400 W CLOCK ti 04r
�� ELEC _ICAL - sdc Ian
�V 4 -CLEANER.__ great white
`line tablet
EM.
_FEE DE --------------.. � ._
STER C 0 pebble tec c_blue
_ECI.,_'Y t rs SQ. ---
jandy 4 remote - — --- - -- ......- -... ...
DEC P cant.c__ap.. on_r_b.b_
PTr C t. FT.
u SPA SPECS.
lites on dimmer switchQ� Z 7' RAISED +18"
L ...._ .. 1 00 - WATTS
--....
RI LEVEL SEATS 22" 24" 27" _
GjJ X10 DSI E DAMWALL quartzite -grey -spillway
Q- DAMWALL TOP tiled
i n SPILLWAY SIZE sel�X9raw WIDE
TE SPILLWAY_._.XX -CLOSED
n �, _# JETS 7 - -UPER -_- . LOWER -
V -24-97 s abooster-starite 1.S 11. P.
Name: Bob and Madonna Wilson
Address: 54-366 Shoal Creek
City: La Quinta
TRACT LOT#.
AM
�V
_B13
110650/1
CO� HE L •L,�S r_
...... Affigh
'LA QUINfA, CAU253 V
" • �/
NOTE: LANDSCAPE AND FURNITURI�
®� ARE SHOWN FOR ILLUSTRATION
r ONLY AND ARE NOT INCLUDED..
PALM DESERT
73-011 COUNTRY
CLUB DR. STE F-4
PALM DESERT CA.
92260
(6.19.) 34.6._4032
TEMECULA
28910 RANCHO
CALIFORNIA RD.
STE 206
TEMECULA CA.
92S90
(909)67.6 -SWIM
—.