0003-208 (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 A 08/31 /204
Date ? � `r Signature of Contracto`t --"�
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 _Policy No.
.^i'1`t'�e�i.•. FUi�`.D 6.116-0040r.9311
(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: 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
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.
Signature (Owner/Ag t) �f "'g ' Date - °'1
PERMIT #>
BUILDING PERMIT �1ai�►:�-�x
DATE VALUATION S34.000.J_10 LOT TRACT
JOB SITE
ADDRESS _U-5245±4OOi'IEMRN IRILLS APN
OWNER
CONTRACTOR DESIGNER ENGINEER
841101. ANb_LT11,1R S'!7ET. DODSO;`: C0,11 9},1 7
0N
54-.526 OUrHERYv HILLS 73011 COUNTRY CWH DR., u'Url''C x'41
LA QUINTA CA 9'2253 PALM DESERT CA 92260
(760)346-4632 CARL. # 1044
USE OF PERMIT
KKA F1NDA)R SPA
POOL & SPA ONI V ALAR1'1&GAi2IUMS SffALL BE 1N PLACE A.1
a lJ UAnl Oii
34,0K00 LS
PERM-FIFET11SUMA"Ry -
P1. AN CUE FEE 101-000-439-318 5201.O
(;fCs1+h3.fSi` +?'tCf�n AT(C.17�� �} i.'i?n�1� 110!1-000-418 yn�-/0��0�/0� $3111).50
NIECTR1CALFEE __ POOL. 101-00U-420-000 JA 5.0
F'i.ifi'VWNG FEE'— POOL 10.1-000-419-M $27.00
51:. RIK)TAC. CON9TVI '1'1ON .KNP PLAN C.1=g'rC K T,f�Yt 33
LESS PRI? -PAID FEES, $0.00
TOTAL PERMIT 0119 NOW
RECEIPT DATE ( BY 1% } DATE FINALED INSPECTOR
raw
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_
Electric Bond 17 V1 -
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 s
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:
.s -O �- =; ' • - •' �. -
NOTES: - —' - r - t - - - 7 -_ _- "t - ,:� - ." — llama ,>s 'n" �.«ioXo « SRE •13.8"X 32�— ... .
< , • A = •. • 60MIL VIS�IR4E _ ' - + - ._ A 3-_PE[UMET-A 82_ . r
AND 2" IMPORTED SAND - , v
DEEM 316AZ FLAGSTONE '3.CAP ALL SPRINKLERSDRAINS ETC -' I ■ P T . - D
" l r "` � F _ • ' REmOVE 842 SF OF CONCRETE - - .. , - - - 35'@+12' 9'®+18" .
DOPING -CANTILEVER I
+ ,
TE10590
NCANTLFgn
CAP ,
• " ^L •. R , - + ., • - - _ PUMPCAPACfI'1' 1_03 GPM
- - �. •
✓� r•' ._,• p,. r - +• r �i ' - . `_ NOTE: ARIZONA FLAGSTONE • fTA R"E ^ HP 1.5
STUCO FACE
BACKSIDE 5100 BACKSE mm
'P ` . _+ - .� WATER 11NE. Fr
- STONE VENEER „ ` • TO MATCH HOUSE - - - ., r ,, , AND RBB VENEER - FILTER STA RITE ; 00 GPM • • • A
,. FRONT - .. • • .. ..
• �— -- 32'-0' -- — —> HFavt AARS Wf_A0QHILL
MRS
- - e F . 1' r • s. a r
rHFCK vALvE .YU_ ... _
` ri _• .. ` ; _ r +, C�l4R'E BY $iiC _ FT- 73 b i
. s - • _ _ , POOL LIGHT 4400 W ' CLOCK RS4 0
.. '•,, _r - - - A _ - _ - - -..... . ' ' , a
ELECTRICAL FT 160 _In
STONE FACE BENCH r ACS—CHEM FEEDER WATFJIBRITEE O
--,! • , - .. •• ... , * •, . .`•,4 • BE#KN- 3� +l + i � ,�. � S• [! P
1066
O
6'6 `' - ' ODNCAETE tiY SIMON O
AIRNPE, - * V9. •. "a - - SILT r ,
5 . 13'6"S sTv , FT.. N
ry - -y " - , 7 �• y 1 • T STA SPECS.
13'-9' �' r - - - l DESIGNER `'a 7 RAISED HO .
r,
` 13.12 . DECO GRAIN P/L LRE 100 ,jr_
.. _ .IOFiJlEV
A � LEVEL SEATS WATTS2" 24' 27^
I r. •' , P/L -6" t j�..6 / - - _ . - DATE OAMWALL - 6' X 6 FT.
—,----___✓� r — .i _ . r• ,.-,__...... - DANWALL TOP
1�.- , DECK TO REMOVE.
3-14-00 • SPLLWAY SIZE 3'X12" WIDE
:22'-9'; , y „ _ - r_r CICMD
REVISED_ -
T .� 4
SPA SIDE SWRT.H, i. - , f - .[. ' s - ...•+� - rt Ramp: BILL.ANID KAREN PELLTTIER f ..
NQ BY OWNER Atlas: 54-526 SOUTHERN HILLS Q
•- _ ., u a : _ . �' a (MNTA
_W
5•-0" MONTECITO •LQTAI. A
lAND�' RS -4 R_ ESIDENCE �: :_PGA
y:
„ STUB BY SDC ONLY o�/i%\
�C .s:f5 EQ 32; OD
N f
.r' I n•,� •� • ){ t + f C ', - • WATERBRRE _ • •„ `T' �• .:w' .L• ..
, PALM DESERT , TEMECULA
i " •' , - _ - •
WINGWALLS ((4'X4') - 73-011 COUNTRY; ,' 28910 RANCID
t _ CLUB OR_ STE F-4 CALIFORNIA RD..
` . + '. • ,, _ ' - r a. • , _ _ 1$=1' $CAiE PALM DESERT CA: STE 206
TEMECULA CA_ - 4*
NOTE: LANDSCAPE AN�DFURNDTURE 92260 92590
OBCAT ACCESS ARE SHOWN FOR 1LLUSTRATlON (2601346.4032 [909167 bstMN4
NO R&.R { M&Y AND ARE NOT INCLUDED- - A-574127 e
A'SI?i�11tl�i- or-�3lr CITY OF•LA-QUINTA W
BUILDING &SAFETY DEPS
- . . 0 �t o APPROVED /.
FOR CONSTRUCTION