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0308-040 (CP)LICENSED CONTRACTOR DECLARATION 1 hereby affirm under penalty of perjury that 1 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 656328 CSI HIC C 1 09'31M /Date _ 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 f_f,CATg j70Policy S ij. Policy No. 046-616 8-2003 (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 proGisions of Section 3700.of the Labor' Code, I shall forthwith comply with thos provIglo Date: Q4 ur - Applicant oa Warning: Failure to secure Workers' Compensation co erage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000,• in addition to the cost of compensation, damages as provided for in Sectiori 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and ,restrictions set forth on 'his application. r 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize)representatives of this City to.enter upon the above-mentioned property or inspection pur�jpo Signature (Owner/Agent) //!dam J" ;.�Sr✓ Date 7` Y` BUILDING PERMIT. PERMIT# ' DATE VALUATION LOT TRACT JOB SITE ADDRESS M-750 TM.00Y PARKWAY , APN OWNER CONTRACTOR / DESIGNER / EN (NEER W -FIA HOMEAS CALPORMAPO©LS & GRAS (TOP MAW CO 81.260 AVhNli3? 62 86-100 A 'CTE 54 -LA, QTt'W,A CA 92893 COACFIEULk C.A. 92 236 • (7.60)398-9222 Cly 00355 .USE OF PERMIT POOH. ANDRA. SPA. CIDM'IMERCII.AL SPA67, € ER APPROVED PI.AWS POOL AtJi: IOR SPA us - .EST %.4�SAARM:I.)'l COST OF 40.1.7F=CY60ltl iTpFNPW Sii7 FIERAUT kWE XlCl.Idffb$ANY PLAN CHECK FER I ?11-000-439m3 18 CONSTRIXTION ,FT -'9 101-1060.418-000 $09.00 XECILANICAL FE - POOL 101-000.421.000 $74.00 ELECTRICAL ra -+ PODL 101-000-420- 300 $45.00 PLUMBUITF'I?E -^ POOL 101.000.419.000 >8,,T3D-`�`try°l."�lL C�.3.NBMUCMOid.{�.�TDTLAN C.`la; $259.35 LFZS PRE-PAU3) FM n TU-rA L PMW S DU E NOW. S2.59.15 EP . 0.5 003 Or. LA QUINTA. r ; CITY airs DEFT. ECEIP ° "" •- DATE / BY DATJ� AL .G' � d� INSP C R ' ZP., W 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Footings Electric Bond 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 Connection Encapsulation L I a 3 Gas Piping Gas Test . Appliances Final / a Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacfes G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: L County of Riverside - Health Services Agency Department of Environmental Health Public Spa Specification Sheet Owner ame/ ddress (DBA) J ► D� City1. 12Wt C I?_ 1 Contractor's Name,/Address(�A tU City./sem l� 1 Pool Location/Ad'dress SP�., Fax No. �&.o City-" Iz sle I I l Plot Plan - Shows all existing and proposed facilities including spa enclosure Scale (1/2" = 1 ft) - Plan and profile drawings ) Mechanical equipment and plumbing lay -out onplan Approved restrooms, showers and drinking fountain if any dwelling units over 300 ft from spa Pee r^`°�°`' POO Spa Capacity2 %V ._Gallons Surface area sq. ft.: 07 �L PM/ ����..�c� fo �f d � 23/0 No. of skimmers_ Make 4a ,,A.. Model A 0712:'& Proper Equalizers Anti -entrapment cover Number of return lines '2- Type of pipe: PVC Sch 40_Copper Pipe size at head Pump: Make Aws—Model5P30(SE£AZ- Hp 1 �x Gpm @ 60 ft TDH I" Filter Type and S e: D.E. @ 2 gal/min/sq.ft._J ' Sand @ High rate - 15 gal/min/sq.ft. Make 14e%yav @ Rapid rate 3 gal/min/sq. ft. Model D l± &O 2-c�. S eation Tank:.Make Model Dry well size _2 ft x_12ft Diam ft Back-viash via legal air gap X Site glass Sewer Dry well I< Spa Construction: Gunite 7 Other Color: AIJ-p- Chlorinator: Make 11,1 EoW Model -3Ob- 2 - Flow Meter: Make tOkp j-Wn \-e. Model E LQM0 Influent and eluent pressure gauges Hand hold around entire perimeter: Bullnose Other X ----All corners coved Split main drains Anti -entrapment cover All Spa safety signs_ Body hook & poled Life ring L: roped Proper steps Proper ladders, recessed steps, grab rails Proper hand rails_)� Depth markers Deck drainage Unobstructed non -slip walkways '4 ft wide around 50% of spa 'perimeter_ All pools at least 6 ft apart-*,Vti'ater supply and fill line from approved source and approved back flow preventer Approved test kit -Underwater light All valves and controls identified A 5 ft high fence around -spa with self-closing, self-latc gates, gates must open. outwards Openings in fence must not exceed 4" wide and 2" at bottom Contrasting tike for step E id bench_ Spa emergency shutoff switch�_ Additional requirements: