0006-073 (RPL)+ 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 myLicense is in full force and effect.
License # .,' . Lic. Class Exp. Date
556236 03 U
ate Signature of Contractor c,
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.
( �) 1 have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work•f6r, which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 15'96269
(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
wo�(ers? compensation laws tdf`C`alifornia, and agree that i i) s o ld become
sybject to the workers' compensation provisions of Sectio 37 0 0 the Labor
#lode, I shall forthwith comply °v ith those provisio`nS
/date: Applicant-
Warning:
pplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criiiminal 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
;t/habove-mentioned prope� r inspe�o` p rrp se
Signature (Owner/Agent) r . Date
BUILDING PERMIT. PERMIT#:
ATE VALUATION LOT.. -07N `TRACT~ '
4
JOB SITE ar[��y yY APPI
ADDRESS
lli�^C 4 919NA ' d
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Ge r 16 e r
aUNRsErloLsY�
-7�A0� tMMYsaXT
.44028 E-IMRORi4 11L
LA QUINTA CA 42253 PALU D SERLT CFS 92255
(7610)340,-5521. CB1A 3604
USE OF PERMIT_
POOL AND/OR SPA.
a•
{
POOL &SPA ONLY- ;ALARMSVIIA:RRIER.S S1'IA1,,11, RL IN PLACE AT
PR&PLAS'YER INSPECTIOW, THIS PERMIT I OIS NOT .INCLUDE BLOCK
WALL FOR EQUIPMENT ENCLOSUIZ.
VALUATION
10.500.00 W
ES'M.11ATM COSY' OF C.ON57P`,�i7MMONI
i1�,�C3iD.�
PAY' Fn 4014MARY
PLAN CHECK FEE
101.000-439.318
$123.70
CONST;iUCTION FEE
101-000.418-000
$198.00
MECHANICAL FIDE -- POOL
101-000-423.000
$24.00
?tI..1y. CTRICAL FZ •- POOL
101400-420-000
$45.00
PLt.IMB Nc3 FRE -- POOL
101.000.419.000
127,00
a
k.
1M-MTAL C -ON 'I UC'`TION AND PLM CIRCK $422.70
LESS M-PAIDFEW $0.00
RECEIPT I DATE I �1� / f/ I DATE FINALED I INSPECTOR
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
OX 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
Underground Plbg. Test
s db
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
"GENERAL SPECIFICATIONS
POOL SIZE 1`
' -;aBEcom POOL AREA 295,1.7POOL PERIMETER �49t
{ -I/WE `U;`�CERSA�`�D THIS,IS A FINN_ L?�',� .f:- '�IsCM ttiDEPTH
:� „ � �., , :;'� ' D A. l 1 h1G HJ THE �E _ A s ,�
A N 1L i L a _+ `. _ . 5 _> . y i,�NE C O I N G
N TILE CHOICE e5r(:2
POOL CAPACITY Arl-k-OX 12 rx-)c
MODIFIDA-FiONS WILL NOT BE H Ni C., E7D -PUMP CAPACITY inn aAL- mt-�
�_. ��IA�UNLESS ACCOMPANIED BY;A'SIGNED n! & ,he tut
ERPRIOR•TOANYWORKSEI.NG Bu�r5R�� g
'CHANGE .
DONE. _
DATE`RETURN LINES
POOL
FILER
a
FILTER RATE
TURNOVER
MAN DRAIN '
SKIMMER MODEL at
LIGHTS
TIME CLOCK
ELECTRIC 22-C) Vr-21--L
�P/L POOL CLEANER NJONE
I _DIVING BOARDSLIDEF
wf-
•
QUARTZITE ITE W/F - .6
7 ' 0" 17 ✓ ACC Ss
r 18f� R% 0 DECKING
RAISED BOND BEAM
_ R p ' PSL
• E' SPA SPECIFICATIONS
. . _. _ •F • • - I��CKING - - - slzE -7'
SHAPE CUS-rcm
_. •---=--------------------------------------------------------------------------------------------=-- JETS 4
• . _ RAISED
REMOVE CONCRETE
BENCHES
BOOSTER
GF-I,Ofp FAMILY
r POOL �EQUIPMENT _ �A QUIN1"A, CA
4-P%L >5 ' F-x1!5L LNG 1,�51pr- NCr--
- s I . . _ • �� APPROVED BY: cnp-y -
m (760).340.5521 THIS DRAWING REMAINS THE PROPERTY OF SUNRISE
PALM DESERT, CA WI HOUTPPERMISSION S PROHIBITED. SRIZED USE