0207-030 (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 # v n �aLicc...Cel7ass Exp. Date
d� l) ee l
051 0,3 - VSA i �M1i
Date: r' Signature of Contractor
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 MID -Cid' `I`URY Policy No. A0193.00 -V
(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.l should become
subject to the; workers' compensation provisions of Section' 3700 of the Labor
Code, I shallforthwith comply with those` provisions. .
Date: -'" Applicant' �: -Y'"` _^ •fr
,
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.
s
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. a
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 uporti
the above-mentioned property for,inspection purposes.
Si nature (Owner/Agent) - "` r Date `'
I BUILDING
PERMIT PERMIT#
-
O�,CA'�••C�J�
DATE . VALUATION ,J� �9��J �yg� LOT
VD'.fiwtlY.rV'�,6?6Y �
TRACT
!. •
JOB SITE
ADDRESS 01_64'-) T
APN
.P
OWNER
CONTRACTOR / DESIGNER / ENGINEER
74*9231110VFj,Y I,al MEAUr .g.UTrL-2-420
41555 YUC(."-ALANF,
PALM .'O?SoERT
CA 92260
THS
BER�+,M�(.i,ry����
92201
�11(��qinr
ppyyo�6
USE OF PERMIT
POCti1.M]:J.OR EWA
IUSPA, fTSLA�Ip'.CA�fQ�tJ�s',FF3+A^g:�E�.PJFRS Sii.A1:,I, VE 114 PIsACE PRIOR TO
.
7fPOC
P001.AND10ft SPA
J0,108010 LS
FWIMM) COST OF C'. XVI RTYM, 10N
1'ltiIWr bM' WbWARY
l LAX CHECK FE -19
101.000.4,39.3:1€ $12MD
CONSTRUCTION FtE
101-000-41I3-= $19$.00
MECHANICFEE •,- FOOL
101-000-421-000 $24,Mt
F TRIC A1, Y279- .:n POOL
101--000-4-20-000 USX@
PIAIhIRINC+PEP -POOL
I014C>T'i419-000
sug
.�....
1730.:inn PAID Fr=
$0.00
CITY OF LAQUINTA
FINANCE®EI'F.
RECEIPT
DATE
iBY
D I
SPEC R
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 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
Final
Underground Plbg. Test
Gas Piping
t PLUMBING APPROVALS
EacTestric Final
Waste Lines
Heater Final
Wa'�ar 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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.f
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Final
COMMENTS:
_
SPA +18"
9' WIDE STACKED G?L
DECO t)RA
EQUIPMENT
STUCCO
E01
DESERT CITIES
CONSTRUCTION
Qc :rrB-651503
POOL 5PEC5
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SIZE: 1036'
AREA: 533 SF
PERIMETER:: 97
DEPTH: -3'X-5'n
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SPA 5PECS
SIZE: 6'X lo'
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AREA: 6o 5F PER 32
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DAMWALL: Is" WIDE
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RAISED @: +is"
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SPILL TYPE: QUARTZITE
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# OF JETS:
LIGHTS: I-100 wA7TA
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FACE FINISH: STUCCO AND PAINT
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DIG/ EL
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TYPE: BOBCAT
ACCESS: SIDEYARD
ELEVATION:
DEEP RAMP:
NATURAL GREY COLOR CONCRETE
BENCH/TAN-LEDGE:
BROOM FINISH
cONc/sOD REMOVAL:
TREE REMOVAL:
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IRRIGATION REPAIR:
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RBB LENGHTS:
ROCK POCKETS:
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FILTER:
L:T'ER: 300 HAYWARD
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POOL PUMP: 1.5 HP HAYWARD
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BOOSTER PUMP: 1.6 HP HAYWARD
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EXTRA PUMPS:
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HEATER: 400K BTU HAYWARD
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TIME CLOCK:
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SUR PANEL:
EXTRA OUTLETS:
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SKIMMER: INCLUDED
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AUTO -FILL: INCLUDED
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GAS LINE:
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STUB OUTS:
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CASCADES: 3-24" WIDE
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SPRAYHEADS:
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POOL LIGHTS:U-
2-400 WATT
SPA LIGHTS: 1-100 WATT
PLUMBING SIZE:
STUB SET EQ:
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DEEP END RAMP:
2nd STEP:
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SPILLWAY TYPE:
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CANTILEVER:
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COPING:
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TILE TYPE: GROUP 3 6"X6"
WATERLINE: To BE SELECTED
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TILE TRIM:
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ROB TILE:
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DECKING
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COLOR: NATURAL GREY
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SQ FT- 77oSF
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FINISH: BROOM FINISH
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EXTRA JOINTS:
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CANTILEVER:
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DECK DRAINS:
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DECCO DRAIN: 6o'
CURB CORE:
STEPS:
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STEPS FACE:
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SUB BASE:
visQUEEN:
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BANDING: 12" CALIFORNIA SMOOTH
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STAMPED:
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RELEASE:
MOW STRIP:
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MASONRY
COPING TYPE:
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ROB FACE:
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SPILLWAY:
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P/L EXT WALLS:
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PLANTER WALLS:
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RETNG WALLS:
EQ WALLS:
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GATE TYPE:
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R&R GATE:
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SIZE:
BBQ MODEL:
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TOP FINISH:
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SIDE BURNER:
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FACE FINISH:
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PE N LIGHT:
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PLUG OU -FLET
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LIGHTS SWITCH:
PLASIER
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PLASTER COLOR: WHITE
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PEBBLE COLOR:
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POOL LIGHTS: 2-400 WATT
SPA LIGHTS: 1-100 WATT
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ROLLED BOND BEAM:
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EYEBALLS:
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OTHER
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PI -AN FOR
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TOLL BROS LOT 28
ADDRESS: 81-645 TIBURON
CITY: LA QUINTA
LOT #: 28
REVISIONS:
(1) DATE:
(2) DATE:
(9) DATE:
Date Printed 1/8"=I' Scale
1:49 PM 7/8/02 r -H gtjm-u
Drawing by: eric valdiva