0006-215 (RPL)LICENSED CONTRACTOR DECLARATION''
I hereby,airWrn 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 # Lia Class-\ Exp. Date
ate �/ �i nu Signature of
1
OWNER -BUILDER DECLA
J
I hereby. affirm under penalty of perjurythat I:�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 Policy No.
�.iATE FUND Policy
(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
su ptect to the workers' compensation provisions of Section 3700 f e abor
Zde, I shall forthwith comply with those Iprovisi ns. /^
tp,' Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to crimin�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 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 for in, purposes(/I��Date S)'nature (Owne0Agent) �� �� I r:
BUILDING PERMIT PERMIT#
ATE! VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 45-4W -SUMR00r,
OWNER
CONTRACTOR/ / EN INEER ,
GUERRA,
.sC.)k7 m AOb1.6
45450 5' HU3.UOK
440261aXA ?F,NM.
LA QC?IN°lWA CA 92233
PALM DF. MKT CA 92255
(760)34.0.5521 C33T.O 1604
USE OF PERMIT;
FOOL ANDIOR $1• A
POOL & SPA ONLY- ALARM',ARRIZRS HALL til, IM PLACE AT
PR&PL.ASTER INSPEM1014. BLOCK `NALL FOR POOL EQUI.PMENT
ENCLOSURE IS NOT 114CLLlDED 114 THIS PERMIT
k
VALUATION 15400.00 LIS
X.
MO AM COST OF CON'S'i° UC770M
PFRhIi'It' 8UWAMR '
PLAN CHECK PER 101.000.439-316 5111.15
G",tJl lu'1 RUCTION FEE 101-0010.416-000 $171.00
MECHANICAL PPE •- POOL 101-000.421-004 $24,00 -
RUCTRICAL PEE •- POOL 101-000.-420-000 1145,00
PLUMBING FEE POOL, 101.000.419.000 $27,00
SUB -'TOTAL COMER= 10W AND FLAW ('11MOR
$378.15
1=-PAID'FM
50:00
'1r'OTAL P113MT FEES DUX'140W
RECEIPT
DATE
DATE FINALED
INSPECTOR
r [
INSPECTION RECORD
OPERATION'
DATE I
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
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electricl
Underground Plbg. Test i1
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. f.
Smoke Detectors
Temp. Use of Power .
Final
Utility Notice (Perm)
COMMENTS:
GENERAL SPECIFICATIONS
POOL SIZE
OOL AREA
f POOL PERIMETER,
-DEPTHTILE CHOICE
fc a
COPING
YT . ` . t . F a . - •.
AF f. POOL CAPACITY Ar�rj��< 12 C2QC2
x UMP CAPACITY
FILTER RATE
TURNOVER
VACISKIMMER 2''
.. - +6„ PSL .� _ .MAIN DRAIN vr?kyr::X
RETURN LINES
,
,. Q A
-�-�/ LA -
• OF_ UIN 1 E MODEL
• ,. DEPT.- 'FILL DEv'cE
BUILDING & SAFETY D -Ad 1-rr)AA
GASLINF
. -PRAYHEADS OVED +.
TION -
33`' 0" 15. 61
FOR CONSTRUCTIONSP
1 COC
21
ELECTRIC -2aQ V(
` , t►' OATS
+6
DIVING BOARD
F DECK i'NG 6' -o„ j : ,w - _ . . I t . a
,LADDER
y . SLIDE
A :RE -INSPECTION EEf OF $30ROPE
-- -- MILL -BE CHARGED If THE APPROVED _ CSS os
PLANS AND JOB CARD_ ARE • NOT ON •
_ -THE SITE fOR A SCHEDULER` -
4-6 1011 EXIST I,NG 'RESIDENCE yINSPECTION. SCALE
°
• - .SPA SPECIFICATIONS. y
r . SIZE
SHAPE CUSTOM ,vs'
POOL EQUIPMENT . JETS
. . RAISED
BENCHES _ - -
i . * BOOSTER
iv(1 - X
•�'tQ PAM GUF-ppA '
�NI1}1210M i rI a f 45-4 5 0 SUNbwooK
01-�01�Ad 0 E0NVH0
C-,���IS'� A9 0 1NV; V%1.0�O �S� iNn LA QUIN1'A, CA
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3S1
� O /Cl N Vi S 3!D N V ¢¢ v�' 'i V 1'' `_�_• 3:�.� f - ��� APPROVED BY:
4. "JI—D.,
10)
J U Si f N I/Y1� UAW (760) 340.5521 'THIS DRAWING REMAINS THE PROPERTY OF SUNRISE
n n _ POOLS. REPRODUCTION OR UNAUTHORIZED USE
r . `i j;Ai'1�VC] V IV
N j I S H1 i� �� ���.is j j j, �1 � j r PALM DESERTS CA WITHOUT PERMISSION IS PROHIBITED. -
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