9910-119 (RPL)LICENSED CONTRACTOR DECLARATION
'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
ate °�`° , �` Signature of Contractor - �PL'
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&RC. 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.
( A 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 �,. r ,,,V, Policy No.
(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
workersfcompensation laws of California, and agree that if I should become
subj' dt to the workers' compensation provisj,lQns of Section 3700 of the..Labor
C ?e I sha�l?orthwit comply with those p'r0isions.- ,.....,..�—
Date: i/� y Applicant""
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that:[ have read this application and state that the above information is
correct. [,agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the b�ove-mentioned property for inspection purposes. .
Signature (Owner/Agent) ` 7`Date °''
r
PERMIT #
BUILDING PERMIT
DATE .// q ,, r. ,)y)VALUATION LOT TRACT
JOB SITE
ADDRESS 45_C410iY G� ��i i �W. :� g E ,ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1;?€)17�I�}�i:
q fpm
4:�'t,�{��iAl. E
;,r:'?'
t,�'tc�`<?��ayo[J I
v.�.i 1, �IXNJI1V I. K�� t, al �Y.. .4�i�l.a �.7WI W� F-1
USE OF PERMIT
K-)(ai. iXAt A)"" SPA
Vk,A.1, c",:. , Ri.LFPA°ilk`L1:�fpoilL`�$II�iLYCk./tt:;►�,°.J9' .tp�) i'�iA,,(Ati�pk: A,I
q"f3.pp'��.'-AiL Sk tt'- a�9S�I1-�A_:.,�L4k,
P KIt-r4,X A`LR J6V i7)�d� Ht t4. rY�l fi�i' A�dt,^,I3 `IONA](.rty ��°-,,
N, £4R3,.`_� !-'? )i� 'iblp ?a< d ►�s4.s't akE C�IY��' `�f °'1. ,•aF��"�ilp P'
M
�i
p-l"ttjU-f 'y:W;:S IYJ` 7,3iiu
PiLANN0,1111A% FPLV 301-t3tz�i�1"�.,,`t��
r�tl� pit=r�t`i Tft iN t' v ifi@ 4n)
"�2r'-;t:`,�i.4��llr.,.rl�, d"��, •�"tir.?. %�)Y �S�i)=�a� S ��?� �.�$�I�,
.,:�a
—n
4;$at �S�d�4Y:t$+k �.� 'a f�)t.li� $�8� f_��i�-'a���3•x�i$� �J<'. �'-V�
�C:)'-
1tdL°::err ►�i� �'�('itiV �`�o>= 1�Dt<ti��►m.3?�;�t?�!.3� S�1'�3 +ftp
�' C I ?
�
cj n
rn fTT
f7) t_J
RECEIPT
DATE
BY
4`
DATE FINALED
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
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)
Y-
CONTRACTOR cannot assume res on ibili y for GENERAL SPECIFICATIONS
damage to curbs, sidewalks, drivewav�, m n SIZE 14 X 25 y-+
slabs, sewers, lawns.trees, fencesre
. taining
walls, sprinklers, telephone lines or shrubs. AREA 280 PERIMETER 78
When access is made through a neighbor's DEPTH 3x5
property ty it is understood that you, thethe—e owner, TILE CHOICE VM 692 SQ. 65
have that nei hg bor's permission and assume full BB• 'Q+6" '@+ '2"
responsibility. COPING CANTILEVER
DATE _�— signature POOL CAPACITY0 '.
#. PUMP CAPACITY 103, GPM
GROUT COLOR MOTOR HP STA RITE Hp 1.5
Ci #190 BAY LEAF Mo"pp mm = = = = Mir
f , ' FILTER STA RITE 300 SQ FT
FILTER RATE lo2 - - .• - . , ; GPM
SPA ® +12" HEATER -LAARS SIZE 250 BTU
k ZPIPE TURNOVER 2 HRS
SUCTIOLINES
N 2 n
. RETURN LINES 2 "
'bSKIMMER MDE AMERICAN
YES
/L GASLINE BY SDC FT. 100
POOL LIGHT 400 W CLOCK T104R
14,�0" f• :I!z3'-6" ELECTRICAL BY. "Spc FT, 200
25
_ �41.30` PLASTER COLOR
WHITE
DECK BY SDC SQ600
DECK TYPE SLT FNHS NTRL GRY
STEP= mmmmm0l
SPA SPECS.
1 Iv LIGHT SWITCH SIZE 7 RAISED YES +12"
DESIGNER
` LITE 100 WATTS
1.7,,9 " RANDY/BV ,
I<5.6 RI LEVEL SEATS 22" 24" 27"
,.
P/LDATE DAMWALL .6" X 6 .FT.
8-17-99 DAMWALL TOP TILE
" SPILLWAY SIZE 3 X 12 WIDE
ER REVISED P . WAY XX P LOSED
SLIDERSLIDER B I o °0 F Q U I N TA. # 4 U R LOWER
G & S FETY DEPT
MASTFK, ® - �5'" _ fie: CENTURY HOMES/CRONE
. BEDROOMvE�
BEDROS
250 FOR CONS OCTION Addresso PENDING�/S`�(/a
SLA QUINTA
DATEy IRAQLSIENNA DEL REY LOT# 7�
_ EE 6f sn
..RESIDENCE. A- RE -INSPECTION E APPROVED
' WILL BE CHARGED IF H ON
PLANS AND' 106 CA ARE NOT .
t THE SITE FOR SCHEDULED'
INSPECTION. PALM DESERT TEMECULA
.NO EXCE . IONSI
73-011 COUNTRY 28910 RANCHO
i CLUB DR, STE F-4 CALIFORNIA RD.
1J8":=i' SCALE PALM DESERT CA. STE 206
NOTE: LANDSCAPE A FURNITURE 92260 TF,MECULA CA.
' ARE SHOWN FOR ILLUSTRATION' 76.0). 3.46-:4032 90
(909)676-SWIIM
ONLY AND ARE NOT INCLUDED.,,
#A-•7.1 7