0303-256 (RPL)t
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.
fSignature (Owner/Agent), Date
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
6), SSW C5:21 Hr, 5131,103
--S"21 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).
O 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.
Sec( ) I have and will maintain workers' compensation insurance, as required by
ion 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 CLARENDON INS, Policy No. 06KRB00t3$91
(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.
App
r ,
licantnt -«
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.
S
PERMIT #
BUILDINGRERMIT
0303-256
a vAL,JATION 'S19.0fVi.0 . LOT. TRACT
JOB ADDRESS 757'= AVIrMA. UL-11PAO
APN - -
OWNER
CONTRACTOR/DESIGNER/EN INEER
W, ANIXO):4 A&RO. BKMS
SUM HAWN POOLS
78.535 AYVTMA,T71..TWO
2318 0. 'tib' RYAAD A.'VMWIF, SUITF A .
LA.CjUWA CA 92-253
014TAR1:0 C.A, 9176.1
(809)947.6474 Cam 5240
USEUSE OF PERMIT
FOOL AM/OR RA
' Pa i,' '.E.i. X3 irLI efiibf•?tX:i/
INSPECT .0N. ZQUIPMENT ENCLOwUIIE NOT INCLUD&D.
POOLANDIOR.SRA 19,000,001.3
S
r
FMMATIM :C OST OF +C01g9MUL" .CION
1910M.k'DO
PMWr 56'1X SIWRY '
PLAN CHECK FEE 101-000-439-318
CONIT111.UCT'ION FEE 2.01-000.419-60CI $199.00
MECHANICAL FEE, - POOL 101.0520.421<000 $24,00
ELW,*fRJCA,L FRE •- POOL 101-000-420-000 $4.5.01)
PLUMBIN0 P9I: , POOL. ' 101.000419.000 $ 7,00
" T UC AOU AND .F LAA3 CfiIE=$422.70
�
LM PRE►C'AM FEES
i
MAR 2 8 2003 TAL PERA FUS DUE ROW
CITY OF LAQUINTA
FINANCE DEPT.
$422.70
RECEIPT
DATE r]
.� / • i.
BY
x'/.61
I Dt�PE FIN�L�p��
K/lam/S//
INSP
C
S
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I 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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
-
Equipment Location 16
Underground Electric
Underground Plbg. Test
Final
Gas Piping
,.. PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines,
Heater Final
Water Piping :..
Plumbing Final
;lumbing Top Out
Equipment Enclosure
Shower Pans -
O.K for Finish Plaster
Sewer Lateral;
Pool Cover
Sewer Connection
Encapsulation
Gas Piping.
Gas Test
Appliances
Final
COMMENTS:
- -
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
rim
LIW2
Quality
Since 1954
CALIFORNIA LICENSE 0618892
CUSTOM DESIGN FOR:
NAME
ADDRESS:U`O
lTl
_
cirY:L Vli,I, C 2
//A c9253
HOME TELEPHONE 7�• Sbtl'�720-OFFICE1 `+
LOT: TRACT: -
MAP BOOK PAGE i
CONSTRUCTION OFFICE PHONE,a
DATE: SOLD BY CHECKED BY:
SPECIFICATIONS
TYPE. CVS Ti1ZE. _3 , X -2_w
SURFACE AREA POOL:
PERIMETER: FD r DEPTHS: MIN. __ZL _MAX " -5—
-SPA
SPA SPECIFICATIONS
SIZE: - X�—.,,._SO FT
SPA DAM WAIL WOTH• J2 i P r
NO. OF JETS ��
ELECTRICAL
By, � `LENGTH. C
TIME CLOCK: „ SIS !AM J
1,10. OF LIGHTS M POOL
BOOSTER PUMP:
OUTSIDE G Fl. LIGHTS: GFI OUTLET:
BLOWER ONLY- _
EXTRA SWITCH FOR SPM LIGHT.
RAISED SPI: E5 SPILUNAYS
ftW.._ NOOSTEa
SPECIAL NOTES.
BLOWER CjLEEAWR/--- t _
MISC,
EXCAVATION
TYPE
ACCESS FROM �__:�_ _
TILE 6 COPING
DEEP END RAMP:
FENCE REMOVED BY
COPING WHITE
COPING SPECIAL FA—Li_SrQ
FENCE TYPE: -
TRASH REMOVAL (LOAM:
TAE GROUP: 2-_
TILE TRIM. ,
CONCRETE REMOVAL (LOADS):
r RB B 12 R a S. __—' tr R.B.B.
TREE REMOVAL BY'
MISC:
STUMP REMOVAL BY
rR88- '1IrR_8B
STEEL {'
DECKING
r R 8.8. 1Z' R B ta' R es
IW To —So. FT
FINISH:
SURCHARGE - "'
iOVESEAT INSIDE: r.i S_OUTS10E:
MASTIC: FOOTI ,-
STEPS —
SPA WALL WIDTH: OTHER'.
CANTILEVER: ...
MISC.:
DECK DRAMS ____'CURB CORE
DI CCO DRAMS- _—;— DIVING BOARD JIG _ -
PLUMBINGPATIO
FILTER: 8 N P SIZE -..
STRAPS 6 FOOTING:
POOL PIMP: B 4 SRE 2 P, 2
--
-_
HEATER: R SIZE HOC) K__
BOOSTER PUMP SIZE
MASONRY
FILL INE: SLIDE LINE
COPMO TYPE. `
P•TRAP BACK WASH TOLPLANTER
GAS INE: \ _STUBS_
WALL
-
SHEER DESCENTS
CAP:
LIGHTS N POOL._IN SPA
FOOTINGS 0.8 FACING'
SAW CUT:A CURB CORE:
EQUIP. WALL TYPE: x
M: �IV 1_-,
ISC
NO PIT TYPE. ISIZE-._.�_,
.—E.._
GUNITE
GUNITE INSPECTION RECWIRED: YES OR NO '
ROPE RINGS: GRAB RAILS
rRBB 12 RBB. ___IrReW
PLASTER
STANDARD . STDj s/t-lI T
LOVESEAT: �:�EXTENDED 2ND STEP:
SMART ERRE-
NOTCH BOND BEAM
PEBBLE: _
NOTCHED SPA DAM WALL:
SPA DAM WALL WIDTH:
SPECIAL EOMPPMEENT
COPN6: ,
SMART VAC•—...13�-'�.....�.._.
__._.:_ ._
DIVING BOARD:
OTHER
SLOE: _ �-
POOL COVER SOLAR HEATING. YES NO
FENCING
To meet so local ooee redunements try twyer pnor to
pre -plaster Inspection.
a • OWNER RESPONSIBILITIES
OWNER TO: (11Determine the approximate elevation of pool or Spa at layout on day o1 excavation.
. (2X Take notice thst pool and equfpment location is subject to acceptance of local
building department at Uma of issuance of permit.
(3) Wet down concrete shed at least Wm daily for seven (7) days after shell is
4 installed.
(A) Take notice that BLUE HAVEN POOLS IS NOT RESPONSIBLE tor underground
corxlltions or objects, and any damage to curbs, sidewalks. driveways, lawns or
other items in access area.
(5) See that all lancing, gates, and garage doors meet local codes for • pool enclo-
sure prior to pre -plaster Inspection,
(8) FBI pod immediately after plaster. (Follow instructions: do not use ribber hose)
(7) NO VERBAL AGREEMENTS APPLY.
Owner approves plan, pod, equipment lo" and understands decking Is Iw illustration ONLY.
Owner understands It" are to receive s¢ R. otdecking per contract. .
Signed: -, Date:— ,
SCALE 1!8' . V