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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.
b License # Lic. Class Exp. Date
374127
e Dat 73,V 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.
2 z 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.
S.T KMI !'(Nrl> INZ67947
(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' compens tion provisions of Secti 73700 of the Labor
Code,.l. Li ith comply with those p�ovi ions.
Date: Applicantf, »-"
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. aw
1. Each person upon whose behalf this application is made & each person all
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 au • ofize. representatives of his City to enter upon
the above-mentioned prope y for inspection purposes.
I
Signature (Owner/Agent), 41'Date
PERMIT# i CONTROL#
BUILDING PERMIT 970-141 5621
DATE VALUATION ,$19,409,ftj LOT TRACT
JOB SITE1
ADDRESS 44-•3203WEit,1'31.1SH
APN
OWNERT��
CONTRACTOR] DESIGNER / ENGINEER
��-((�� hh ��
ei`�l DA �f'.,•Al1:
tt�r•� //�� tt
STEVE.DOOSON
44-
73-0 t ( COI3iV'Y I Y C:.LUS t: R.i'� I. VIE. V 4
LA C,}UINT'A CA 92253
('AI M: Di'St;ft.T CA 92.2f0
• � r��:�1�..1u�� �.�?,�:. 1(144
USE OF PERMIT
POOL
POOL -ANli SWA. ONLY
V001, ►?lt D/Ut ISPA 19-409-00 LS
kll�0.lT,iLD��C��'•♦ OFCIXl:Tet+�7�L9�.��`�4�P'8.i%AR
jt.33`V`V9.CI���
.y,+``��••�� ((��{{++--�• ppwS
y��p rS���.+Q FE ARY
PLAN f(FC il�!.ME � (t11 �U) 43y-31� $134.55
FOR 101.000-4.18.0M $20714110
'VX- .Al..��PC, E-••.4r�tr'�.•1�i' L 101-i�t)�0-4211�MO i�3..'�3�.00
``Cp�`�t17r\yy�llTt(w
�:fyLi. i.'iUCAL FEW-- POOL 101-000-420-w .�i4S.00
PLUINUMNO1-11. P NJf. 01ML)w-40-Ow $27.00
4 '
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Lf'SS .PR; �1�=ATfl (�fsS
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JUL 'i'.(4, 6, :Pc12iV r i rims i)(?'3i: ow,
$437.55
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RECEIPT
DATE B"DATE
FINALED
INSPECTOR
i.
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
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
Sewer 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:
3
18" SHEER DECENT
PLANTER. WALL 45'X1 8"/BY D.R.P.
p/a' pl p%a'
X AIR LINE
— — — — — — — — — — — — — — — — — — — — — — —
spa/+12� ��, 6' ._..-...-�I .. +12" 5.� --_ +12"
+14' 7' 0MOTOR
\ j 40'-0" 8i -0n
d% 13'-0" \
tYP i '-egg —
--�--
j ® 3'I0"
_
" 1
tYP.... �.
71 -On
DECO DRAIN ___J.-- f,__--
f/p
slider slider
RESIDENCE .
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` CONTRACTOR cannot assume responsibilityfor
—
damage to curbs. sidewalks, driveways, cement
slabs, sewers, lawns.trees, fences, retaining
DEDICATED SUCTION LINE walls, sprinklers, telephone lines or shrubs.
' When access is made throughghbor's
DECO DRAIN, property it is.understood that you, the owner.
have that neighbor's permission and assume full
— — — — — responsibility,
DATE __=__ si• nature
- -
�� -HEATER
-
i.
,1 1_�" 1
- _ - -- _ _ __
P
DECO DRAIN '
---__=—_ -
h
w
15'
light switch u
o box
CITY F LA QUINT,q
BUILDING 8c SAFETY DEPARTMENT
f, C NCITIOIVALLY
t
A CCEPTED FOR CONSTRUCTION IDESIGNER
-S . UBJECT T INSTALLATION AS PER AMIE
DATE
DATE
GENERAL SPECIFICATIONS'
SIZE 13 X 40
AREA 403 PERIMETER 102•.
DEPTH 3-4=5
TILE CHOICE MDT -.150 S 70
RBB. +12"48'
COPING CANT.
POOL CAPACITY GALS
PUMP CAPACITY 100 GPM
MOTOR HP STARITE Hp 1.5
HP HP
FILTER STARITE 300 SQ FT
FILTER RATE a GPM
'LAARS SIZE 250 BTU
TURNOVER. HRS
SUCTION LINES 2
RETURN LINES ' 2.1.5
SKIMMER MODEL DUAL PORT
C '
GASLINE BY S.D.0 Fr. 43'
POOL LIGHT 400- CLOCK 220V
ELECTRICAL BY. S.D.0 -150
AUTO CLEANER
CHEM. FEEDER
PLASTER COLOR PEBBLETEC
DECK BY S.D.0 SQ. 713
DECK COLOR
STEP FT.
SPA SPECS.
SIZE 7 RAISED +, 2"
LITE WATTS
RI LEVEL SEATS 22" 24" 27"
DAMWALL TOP TILE -
SP MLWAY SIZE 3 -" x 8 WIDE
SPILLWAY x OPEN CLOSED
#JETS 4 UPER LOWER
AND ALI APPLICABLE CODES
Name: MR,MRS KINDA
BY Address: 44.120 SWEETBUSH LN
C'ty:. LQ
G
15 fir.
T �� G•� ��,TRAC LOT#
.
. � bobcat dig
Dosfios
thru garage
POO/S
PALM DESERT TEMECULA•
jE� Copy 73-011 .COUNTRY 28910 RANCHO
/ CLUB DR. STE F-4 CALIFORNIA RD.
STE 206
L PALM DESERT TEMECULA CA.
NOTE: LANDSCAPE AND FURNITUREcA. 92260
ARE SHOWN FOR -ILLUSTRATION 92590
• . , X619) 346 -4032 -SWIM
(909)676
_ ONLY AND ARE NOT INCLUDED. Llc # A-574127