0008-164 (CP)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury0, at11' am licensed �nder..provisions of
Chapter 9 (cbmmencing;"witli Section'7000)'of� Division 3 ofYtheBusiness and
Prot* ssiona!s,Code,'and my License is in full force and effect.
License # x Lic. Class Exp. Date
656128 C53 10/31M
D'
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.
('-f 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 STATE FUND Policy No. 046-00.0006168-00
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
'Date: Applicant—
Warning:
pplicant 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.
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
I' 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 inspection purposes. w
Signature (Owner/Agent) -'` �t -- Date
BUILDING. PERMIT PERMIT#
I
DATE
f ( VALUATION LOT '1 TRACT
t ; r (J ♦ f; 1,�iltTVe�R7
JOB SITE
APN
ADDRESS s o" 4murnr Ma °
rm
-
OWNER
CONTRACTOR/DESIGNER/EN (NEER
aoun.mw IMLS Ll -C
CAiROPICA POOLS & SPAS
1490 E CIWMAN AVE M, 100
74.725 JOM DR1V.E, #A
ORMCfE CA 92886
PAL1i4 UE£, Cr CA 92260
(760)340^9000 MIR 355
USE OF PERMIT
POOL. AMOR SPA
POIIJL $ SPA ONLY - At A.tlM$\Il ARRIERS SHALL, HE IRI PLACE AT
PRI- PLASTER rKSPE(ITIC)R.1,118 PFRVAi T DOER NOT INCLDDi3 BLCX1:_ �
WALL FOR EQUIPIMLNT ENCC SURE.
VALUATION 26,000.00 LS
ENT)'NAI" COS' OF COIrFMUC'ITC:N
2NMWO
�t11w FM 9c7i1 QURY
i'L4N CREC K AETE 101.000.439.318 $184.03
CONSTRUCTION FEE 101-000-418-000 $058.50
MECHANICAL FEE -• POOL 101.000~421.000 $24.00
1U,ECTRICAL IES: — POOL 101-000-420-000 $43RD
PLill 81ING EEE -- POOL 101-000.419.000 =00
• :�Gir3-'1"SAL CC9�1:�1�I.i7G{ Tit<31�• �� }�I.AR1• Clic'
�'�22.5'�
1XZ3 PRE -PAT) FMES
X0.00
TT3'.l'Ai, Mr, RM 1-1061017E ,1 OW
S52-2.53
t
RECEIPT
DATE'S -7 )'
1.BY i
DATE F A D PEC OR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Lacks
Underground Ducts
Forms & Footings
Ducts
Stab 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
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
1A
A
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:
Plan Sets
y Bin
Ci of .. L` a Quints'' ..
Building 8t Safety Division -
.
,�; ,
P.O. Box 1504'
78-495 Calle Tampico
U Quintal CA 92253
- 'Building Permit Application and Tracking, Sheet
Address: Address: S
S o�T z/✓ tv[
6 U Nei
Owner's Name: sow ; < r�Z /�� ' 41 /GLS , -
Project
- -O
_
,
Address:,
-A. P. Number:
-
Ir POoz - 5 pA� %
Leeal Description: C'O!M /•ntJfJ � ` /
City,ST, tip: 6120�C •::
Op L ,
Contractor: �j4 G D/1 tet(/�+. S
Telephone:
T
Project Description: ��Itii�vlJ
Address:
r
n N� Sp/� %b0
Cin•.ST. Zip:
t.
Telehoner
P
State Lic.'. 4
City Lic. #:
Arch.. Env- Designer:
'Address:
Cin-. ST. Zip:
• ;
Construction n Type: Occupancy;
Co
�
er Reair
Detno AltProtYPectrcle one •
ct • P
'•Telephone:
State L
K
Name of Contact•Person`o
Sq•_Ft•
# Stoiies:
}t Units:
�-I'L_J
Estimated Value of Project:
Telephone = of Contact Person:
.:.;>;::.;:::.::.;:.;::-::.::::;.:.;;;;:;.;:.
;-�; ;NO: ;;:.... T.E:.SELfl�:,<HSS,.:#.�.:::�.;:.:;.:<;:.;:::.:;:;,,,.::::::�
Plan Sets
_✓COMMUNITY DEVELOPMENT
_ PUBLIC WORKS
FILE COPY
Cio oQuinta'La
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
mer approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: COMMUNTIY POOL
55-064 SOUTHERN HILLS
Applicant Contact: California Pools & Spas
Application / Circulation Date: 08/18/2000
Date
Community Development Department
Christine di Iorio, Planning Manager Date
J
Public Works Department ,
Steve Speer, Senior Engineer Date
Building and Safety Department
Greg Butler, Building and Safety Department Manager Date
Health Department
Date
Fire Department
Date
Schools Fees Paid
Date
r•
1
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
District Environmental Services Division `\
POOL AND ,SPA PLAN CORRECTION
District No.`` - Plan No.
�( Date
PROJECT NAME—J-6 !� ' ' t C �� - / l 1 (�. C ' 0
PROJECT LOCATION S� `� ( C/ L: C c i, t Y, k1
OWNER / CONTRACTOR � �' �' t ' ' i S r ( - I C r' j "0c, I C .
The plans are now approved subject to the conditions listed below.
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CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections at least three (3)
working days in advance.
A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment, and signs.
APPROVAL to operate shall not be granted until the facility has passed the FINAL INSPECTIONS and "APPLICATION TO
OPERATE" has been completed and PERMIT fees have been paid.
REQUEST FOR FINAL INSPECTION SHOULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
Plan Check By -6 / �_. K C~ Phone
I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction:
Signature`1---
Company C' 141 / - 0,eAflb Poc L <
Date ,,-,,•- Q "7 - (z",,46
DOH -SAN -181 (Rev 11/95) Distribution: WHITE—Office;
C'S
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CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections at least three (3)
working days in advance.
A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment, and signs.
APPROVAL to operate shall not be granted until the facility has passed the FINAL INSPECTIONS and "APPLICATION TO
OPERATE" has been completed and PERMIT fees have been paid.
REQUEST FOR FINAL INSPECTION SHOULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
Plan Check By -6 / �_. K C~ Phone
I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction:
Signature`1---
Company C' 141 / - 0,eAflb Poc L <
Date ,,-,,•- Q "7 - (z",,46
DOH -SAN -181 (Rev 11/95) Distribution: WHITE—Office;
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTM ENT'OF'ENVI RON MENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEMENTAL REPORT TO SAN. FORM # DATE
SUBJECT PERMIT NO..
ADDRESS
INSPECTOR �Jj
,4e
REMARKS: y
N.,
rO
(",4AA K(6VlQQp Q% Ak
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DEH -SAN -1 18 (Rev 2/96) Distribution: WHITE—Office; CANARY—Owner; PINK—Office
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DEH-SAN-118.(Rev 2/96)
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COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY /
F ENVIRONMENTAL �AALTH
DEPARTMENT 0, �_ �2
EhR�ONNIEJTO La.�IATH�-�SE�VIG4ES
SUPPLEMENTAL REPORT TO SAN. FORM # DATE_
SUBJECT I IT NO.
V e 5LkV,\ � Poo
ADDRESS
REMARKS:
I INSPECTOR
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