0103-097 (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
574127 C53MC
Date -"=2r/ a -&/ 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:
( ) 1, 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.^sof the property, am exclusively contracting with licensed
Contractors to construct the project (Sec. 7044, Business & Professionals
Code). i.
() 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.
(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 th,pt if I should become
subject to the workers' compensation provision5bf SeEtion 3700 of the ,Labor
Code, I shall forthwith comply withthoseprovisions; -
Date: ! a'r s ! APplica ntf` .✓ ..mac _ -
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the'Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. +f'�
1. Each person upon whose behalf this application is made & each person'at
whose request and for whose benefit work is performed under or pursualtt to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees:•
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
,permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
Correct. I agree to comply with all City, and State laws relating to the building
,construction, and hereby authorizer representativesdof this City to enter upon
10,
the above-mentioned property fer inspection p�ii r oses:
Signature (Owner/Agent) �' - » DatZ";
BUILDING PERMIT PERMIT#
DATE ij VALUATION LOT, TRACT
JOB SITE nt a
APN
ADDRESS
45,2,_SUPBROOK, LANE
—
OWNER
CONTRACTOR / DESIGNER / EN (NEER
w`
45-250 OWBRO(A 1 -WE
73011 CCI.N'l RY CLUB D1, MATE F4
LA Q133$�`CA Cly 92253
P.FLT±el DEME CA 92260
060)346-403% CLO. 1044
USE OF PERMIT
PIW1.,AN.LVOR HPA
int CUSP.R_ t.L€ R.'A ; ARJUH.RS SHALL 08 i'H Px.,Acr AT PRE-PLA136'KP,
INISPECTION, P001,9QUIPUENT NOT INCLUDED,
POOL A3ti WOR SPA 1,k
WWW"U'D COST OF c(71QI�""rRUCT10IN
21,690.00
MAN CHECK W. 101-000439-316 S146,2$
i:.4JN;;'d'.RZ CINOW FSE 101-000-418-1100 $725.(91
MW,14. AX41C.At M -- P001, 101.009-4421.000 $24.00
ELbX::TRJCAL IEE — POOLt. "i 01-000-420-000 $45.00
Fl:(1�A�+F90 r.1+ -- POOL! ;: 01.000.419.000 MAO
MAR 13 2001
Y v r LA
8U,-- T0i _A. Com:3ni?CnC113 M, 1) PLAN (MMEM
$467,° 'J
13--W 1 `1ZE PAM FM
RECEIPT
DATE }
BY
DTE INALE
INSPECTOR
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Final
PLUMBING APPROVALS
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
1
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
Appliances
Pool Cover
Encapsulation
Final
_
COMMENTS:
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)
t��r^ 0 SAFETY DEPT'
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C,Ti ft88. 1 Tic IH' n
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C (-anule•.er I
•� - DATE._ CAPACITY GALS m
3' r: Tile DamwAt � .—._ signature __ -13.315_._. �
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MOTOR HPAGI'Y •_102 'flGP.
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BY � � STA RITE ID
-hip Fasms for Finish CTilc)� ..
DATE I PRAYHEADS — R3'•6 t, -
FILTER STA 877E 300 -'AIR INDUCTION PIPE FIL7ER RATE 102 EATER STARITE SIZE 400
r,51, -O,".
SUCTION LINES
PXMOVE SODRNOVER--
' �•� _URN LINFS 2 �
4-Isr MMER MWEL AatERICA.\ 3
_ •+, �'- LA QLT\TA HD31E5
_._2S-6'- - +"SWWiLL CRO.-T10V ECK VALVE tF5
r - - H °E- s �. i I - GAStiIw BY SDC Fr. _ _d
6 - _ 3`6• i >♦OL LIGHT 400 W CLOCK TJ 04R O
14'-]O• 1^ -
23-6"
6 TANNING E �H0�3E d
—— I l£CTAICAL BY. FT,
• I 67LID Shc O
1'-8' - L i
_ l4 - - 1' Z
a • P/L 2-RE1OWMDECKCM PLASTER COLOR WHITE .
DECK BY SDC SQ. O
it 28 -IO' V DECKTYPE SALT-HARVESTGOLD O
. - - 10'•3' ,
t - ` / 4.6• •� 4 . r' - y .. STEP COYC FT. r
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— B'-9' -SIZE
I`. FAistine e. m Y ' - - • -f f .OESIGNER UTE 100 • RAISED
5
concrete LIGHTSWITCH - RICHARD'
RE, TM LkVEL SEATS 22' 24"•27•
DAMWALL 6 • X 8 FT- _
• J - ?•• .: DATE _
4'fi' • OAMWALL TOP se
2122!01 SPILLWAYSRE 2 "X 12'•vnDE
a -z r -6 II• # - '.. .:REVISED
SPILLWAY
4 OPEN LOWER-:
RESIDENCE . Pli , ; -
> ALEX NSARTINEZ
AGdlem 45-250 SUNBROOK LN '
A T ci - LA QUINTA, CA m
• - , - •• _ _ I - TRAGI: DESERT PRIDE •LOIti, A
BOBCAT
_ f AR&R- Dodsoe OD
'ROCK - f
' - BLOCK - N
+ '
WALL y ' t •r .Pools N
1 C&E O I
PALM DESERT TEMECULA
* _ - I �_ .� `^� �f6 \ �,.,r • , �" - . • _ _ 1•.
73-011 MUTRY - 28910 RANM '
CLUB OR. CALIFORNIA RD.
k/8`=1' SCALD SLATIE F-4 E 206
PALM DESERT. CA. TEITNECIILA, CA.
' I NOTE: LANDSCAPE AND FURN-[TURE ,
ARE SHOWN FOR ILLUSTRATION 92260 92590
ONLY AND A%tE PIOT 1INCLUDEO_ (6i9) 346-4032 (909)b7- \7
• _ UC N A -CS 3411C-574127 TI
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