0208-292 (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 my License is in full force and effect.
License #Lic. Class Exp. Date ,
Fry S17'3 B C27 L113 4317'2€
Date Signature of Contfactor'"
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.
( ), 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 STATE FUND Policy No. 1O3t N
(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 shal /forthwith comply with,.th"gse• provisions.,., ;
Dater 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 applicatiomis 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)—`�r ' "—~—Date '✓�
'-` BUILDING PERMIT PjRMIT#
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DATE 2, sr _-"VALUATION LOT
as 3f�,t $17,t 2. ;3
TRACT
JOB SITE
ADDRESS�_1gja��f�
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MrIA P ADI.;Ir'Y -
armu h r cr i , 4 oAo#s"haimom
6 c -555 M�r`.�:O N
41555 YUCCA%ANE.
1AQUWA CA 92253
'MUM :I A. 'ieM.'
CA 9122"01
USE OF PERMIT
P0011 AND/OR M11A,
POOL A14110SPACYNL ". ALARM S1•t. 1,L BEft�`'f� ` AC,� k'FiaC)S� k �
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POOL ANDIOit �xA, 1�0ii0;Slp I's
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FINAACE DEPT-
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EMMA TRD CMC OF COR -1
17.0 .00
ill" CHECK PER, 101-000-439-318 311?,OS►
CONSTRUC'I'MW VRF 102-000418-000 MOD
MEC1i.ANWAL" !'"'��M' ; <- POOL 101.000.429.000 S24.0D
k:Ll?ZT1ttf ;AL FRE - POOL 101,000-420-000
0-000
'AL UKEEIR40 R� V, -- ➢ OOL 101-000-419-000 "
01133-T t TAI, Cd)NS1:RUC1109 ANDPLAW CHB=
3Cie. 00
1;'03 FIM -FAM MN N $0.00
RECEIPT
DATE fA!
BY r
D FI ED J
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
'Forms 8 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
A
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"
Sewer Connectian
Encapsulation
' v
Gas Piping
Gas Test
Appliances
Final
D?J
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
1Jnderground 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)
w M 'NTS:
SANDY BEACH PEBBLE COAT C
SPA AT ZERO LEVEL,
TWO LEVEL SEATING
AND FOUR EYEBALL JETS,
HAYWARD REMOTE CONTROL
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LIC #B-651503
POOL sPEcs
Z
SIZE:
14 x 32'
AREA:
449 sF.
PERIMETER:
92 FT
DEPTH:
-3' To -5
Z
SQ
-
SIZE:
7'x 7
AREA:
49 SF. PER: 28 FT
o W
DANIWALL:
18" WIDE
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RAISED c:
ZERO LEVEL
SPILL TYPE:
TILED
OF JETS:
4
z w
LIGHTS:
I- 100 WATT
FACE FINISH:
NONE
DIG E l
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TYPE:
BOB CAT
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ACCESS:
SIDEYARD
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ELEVATION:
Z Q
DEEP RAMP:
o n
BENCH/TAN-LEDGE:
CONC/sOD REMOVAL:
z
p
TREE REMOVAL_:
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IRRIGATION REPAIR:
RBB LENGHTS:
LU a
ROCK POCKETS:
z
PLU BING
FILTER:
HAYWARD 400
a 3 A
POOL PUMP:
2HP HAYWARD
LL �
BOOSTER PUMP:
a
EXTRA PUMPS-
UMPS:HEATER:
HEATER:
40ok BTU HAYWARD
TIME CLOCK:
HAYWARD CONTROL
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SUB PANEL:
Wn}} SPA UNIT
N D 0
EXTRA OUTLETS:
0 z N
SKIMMER:
z
AUTO -FILL:
301-
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GAS LINE:
p Lu
STUB OUTS:
H °
z
CASCADES:
(J
SPRAYHEADS:
u u
POOL LIGHTS:
1-400 WATT
ur
)OM CONCRETE
SPA LIGHTS:
I -loo WATT
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PLUMBING SIZE:
STUB SET EQ:
U
GUNUE
< LL
DEEP END RAMP:
2nd STEP:
LOVE SEAT
ti
SPILLWAY TYPE:
N
CANTILEVER:
z
COPING:
RBB:SEE STEEL
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TILE TYPE:
GROU 3
z 0Q
WATERLINE:
"' z
TILE TRIM:
Q z
RBB TILE:
G m 0 0
DECKING
"' a.
COLOR:
FRONTAS DRIVEWAY
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SQ FT
1,863 SF.
°'
0 *
FINISH:
BROOD
s H
NT WALL, PAINT &
EXTRA JOINTS:
O MATCH HOUSE
CANTILEVER:
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DECK DRAINS:
z C
DECCO DRAIN:
CURB CORE:
H � 111
Z N Lu
s7EF'S:
p p
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STEPS FACE:
0 (6<
SUB BASE:V_c
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VISQUEEN:
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BANDING:
6" CALIF. TRIM(577')
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STAMPED:
q) :DN
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RELEASE:
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MOW STRIP:
x H
w D
MASONRY
LOU z
COPING
TYPE:
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RBB FACE:
0 w
SPILLWAY:
LL
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STEPS:
0�
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P/L,EXT WALLS-
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azzN
GAS AND ELECTRIC METERS
PLANTER WALLS;<
N Q Z
_RETNG WALLS:
Su 7 <
EQ WALLS:
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GATE TYPE:
0
R&R GATE:
BBQLu
SIZE:
Lu
BBQ MODEL:
N
TOP FINISH:
A
SIDE BURNER:
z,
w
y
FACE FINISH:
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PEN LIGHT:
°0-
PLUG OU -FLET
LIGHTS SWITCH:
o
PL R
z Q
PLASTER COLOR:
<
PEBBLE COLOR:
PEBBLe T BE SELECTED
W D
POOL LIGHTS:
1400 WATT
G
SPA LI Hrs:
1 -loo WATT
z�
H LL
ROLLED BOND BEAM:
w , a 0
w
EYEBALLS:
z
OTHER
Q
PLAN FOR
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BRADLEY RESIDENCE
ADDRESS: 81--555 TIBURON
DR
6 r �C� GOP _
CITY: LA QUINTA
CITY OF LA QU��iTA
LOT #: 236 TRACTS 29348-2
REvisiONS:
BUILDING & SAFETY DEPT.
(1)
DATE:
APPROVED
(2)
DATE:
FOR CONSTRUCTION
(3)
DATE.
1/8"=I'
SCCIle
DATE BY
Date Printed
10:27 AM 8/23/02
Drawing by: Frank Guillen
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