0107-222 (PAT)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
574127 A x 13 MC
Date _� /L-42A_ignature of Contractor T Z .�
L'DER-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
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 Policy No.
ST—ATS, FUND
(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.
Date:' - 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 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 property for inspection purposes.
Signature (Owner/Agent)'�mma.��.'� DateA-.;
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE Z
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IZ:ME.1 DO
�3�;V1::�C1��Ci14t GCtk��T1E�3a 7C9A6'71`Z�.
43.660 TALT.i IM C'Q:btNIF
3011 C OU14T Y C �.:€ tB DK, BUTTE N
1.E?a ( Li1 T s CA W 2 3
:t'•� i'' 1,14�°e.r'S.�C1° CA 52260
(760)346 4022 CB14P 1044
USE OF PERMIT
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FERMI FM fir(TWAARY
PIAN CHECK FU 101-000,439-318 Wlt?o
CONSTRUCTIOIN VU '101 -WO -4.18-000 $72.00
STR(.4NO MUCION FE1,11-RESCrj 201.000-241-,000 3.50
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CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewe; Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. -Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
P/L
G&E
01.11p rvrrns for Finish
Quartzite Damwall
P
_ `i
N.
0
COVER
P/A .
�7ivZ 750-rr.Y�
25' -0
"
gn ivi.I
rc -�
V
flit$ ;i11!slll4lilll�I =3- qo
J
i )law ^ r`
�nirtiQ
I i I t
I l' iTina
AIRPIPE
O
20'-0 "
PAL
OONTRACTOR cannot assume reponcih�i�ry for
damage to stubs. sidewalks, driveways cement
slabs- sewe s lawns tMS fences, retaining
walls-39iinklm, telephony fines or shrubs,
When access is made thro��h a ngghbor's
property it is understood that you, the owner-
have that neighbor's permission and assume full
responsibility.
DATE _____ signature`'
��-� /U .O
CITY OF LA QUINTA
BUILDING .& SAFETY DEFT.
F �'
,.P � � } `"�
FC?R CONI' `
�nTG
GENERAL SPECIFICATIONS
SIZE 21' X 31'6"
AREA 360 PERIMETER 91
DEPTH 3'X5'6"
TILE CHOICE GRP 3 SQ.
RBB. 8.5' OF 18"
COPING CANTILEVER
POOL CAPACITY 10,800 GALS
PUMP CAPACITY 102 GPM
MOTOR HP STARITE HP 1.5
MOTOR HP booster 6 jets Hp 2
FILTER STARITE 300 SQ FT
FILTER RATE 102 GPM
HEATER STA RITESIZE 400 BTU
TURNOVER 4 HRS
SUCTION LINES 2"
RETURN LINES 2
SKIMMER MODEL AMERICAN
CHECK VALVE INCLUDED
GASLINE BY SDC FT. 90
POOL LIGHT 400 W CLOCK
ELECTRICAL BY. SDC FT.
AUTO CLEANER
P/A
IE mcao�b�$ S ,rlavib5$
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trnQvA �tzi��oN,
rmQ
P/A
mrf��Eat �# ; I I!
tnc)GA )s97ca
19'-0"
ER
21'0"
DESIGNER
RANDY/RP
DATE
2/22/01
REVISED
PLASTER COLOR WHITE
QECK BY SDC SQ
DECK TYPE COLORED SALT -TBS
STEP FT.
SPA SPECS.
SIZE 7' RAISED 18,,
LITE 100 WATTS -
TRI LEVEL SEATS 22" 24" 27"
ALL 18 " X 8.5 FT.
rDAMWALLTOP QUARTZITE
WAY SIZE QUARTZITE WIDE
WAY xx nPFN rf ncGn
NaMe: RANDY AND ANNA MARIA MEADOR
i
Adder 43-660 TAURUS COURT
QAY: LA QUINTA
TRACT STARLIGHT 3S
TO P/L ES
. Dodson
Pools,
PALM DESERT TEMECULA
73-011 COUNTRY 28910 RANCHO
1/8"=1' SCALE CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT .CA. STE 206
92260 TEMECULA CA.
(760) 346-4032 92590 i;`
(909)676 -SWIM
LIC A-574127