0109-247 (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
11,33
Date`" _ M 7'Signature of Contractor..%'�X, , 1/ X
"""""""""'""'"'•''"'" 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.
(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 Olt
estiora,3790 of the Labor
Code, I shall forthwith comply with those, roVlsjo' s. _
Date: G'=� 2��''y�y%Applicant,,
_.. Warning:..Fzailure•,to.secure Workers'—Gompensation 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 represeritatives"of,,this, City to enter upon
the above-mentioned property for ins�pe�efion%purposes-'�';e'
Signature(Owne,r/.Agent) �'" '`' r`,-•'� ' �� Dated
N d
BUILDING PERMIT PERMIT#
DATE , VALUATION LOT 01.09-247 TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
11WR3AMDO Eq 1;°18 0
cryo. At r'.t/�y'�.{�d�Pjt}:,��ty����.}S,, INC,,
w�{w6.!�,�
•J ��,4i45 .1it!'�4. A CT
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l 0'a 1 80 .i.i1 VAtl,1.dS� R-C'n��L'aiw' 03 .
PA QUUPTA, CA .9225:
RANCHO WRAGE CA 92270
c;) � •c� sca c x;c 3735
USE OF PERMIT
P001, AND101ISPA
TEIR
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rPR'*.��j;,�4y�L
dlileAX",i�Sr'd 1�. N. POOL RAQ1.1J:�S INI 1 �:s C.YJWw!Ciir 9 40 d YS�A�.r%nl��iED.
P1001, MINOR SPA AWAO 1Z
�,`ERD � 06T OFC;'ia.!'�'��I:��I.dt:"�6a.�
p,;, py,'
P'Lr°►:W CBECK FUR 101-000-439-318
01-Q00-4lE•t00 $259.Seo
NnTRRC'r(ONPRE 101-000-418-000
A1µlb01gqyAw&"^POOL 101-MnO421y4}0 $24.00
LarGr3ycdfi+RlYom101-000•41.0-000
101.000-419-000
n
s
SEP 28 2001
CITY OF LA QUINTA
FINANCE DEPT
%W114MUL MMMUC OVIGIT AN °1 PL_
$522;. r 14
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
1
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
POOLS - SPAS
ljyl`�(f
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
'Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Maste Lines
Heater Final
Water Piping
Plumbing Final
Pluqibing. Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
Gas Test
Appliances
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)
Final
COMMENTS:
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR C TRUC
:T4 L� (Jl jY
1qCAL -NEVADA.
PO LS
MARK TOW
701801MUNDER ROAD
RANCHO MIRAGE, CA. 92270
PH 8310960
LIC. 11 777601
Designed by '
KERRY R. KOEHNLEIN
PHONE 360-0012
L kN --e 6-
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G�w�6h <7
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VICINITY MAP
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j�uTa
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OWNER to fence pool area and install self closing and self latching gates per code.
NOTE: No dirt will be removed, returned or graded after day of excavation.
NOTE: Relocation of equipment pad will result in additional cost to owner.
NOTE: FII pool immediately after plaster (follow instructions). Do not use rubber hose.
NOTE: Do not tum on pool light when pool is empty. ,
NOTE: Wet down concrete shell at least twice daily for seven days after shell is installed.
I have reviewed this plan and hereby approve total plan & specifications.
DATE —� CUSTOMER SIGNATURE
POOL SIZE —15 X O Depth -�__ X L-{ X. (v
Surface Area `f J Perimeter S
EXCAVATION Access R 1-� 5 r 0�. Grading kC
Dig From sh ik L.L L> -) Obstacles
Walls Removed - e S Replaced P
PLUMBING after "S'sfta,�zu CAa-r
Size 300
Pump .1 c-2-zt Size Zhn
Booster Pump
Skim Run S'Main Drain U
Ret 3`
Fill Line 14 Li 'tO Purifier
lJ
Auto Cleaner P o 2 1 S
love Seats 6
Htr Type k A 2 Sae G!a o a40
Gas L/F J
FOUNTAINS -SPRAY HOS—WATER EFFECTS
Type
Size
Plumbing Length
Valves
Booster Yes/No Type --N a •
Sae
Misc._.
STEEL GUNITE Eng e5
Sur -charge
6' RBB N 0 12*18'
SpA 24'_
Step Risers (
Spa Wall Width_
Benches A .a
love Seats 6
Spa Dam Wall I Z
Notch
ELECTRIC Total Run L/F 5 0 Fibei-OpticAj 4)
Remote IJ %3 Spa Ay J
Misc
TILE wAjneE b .aQ. 5 Coping N cZ'
Step & Bench Tilef L6 IP S
Misc.—Glass--Etc.
DECKING Sq Ft 3 `�'� Type See.-* _ Color F��G
Nat Concrete Sq Ft Cantilever 5
D.O.D.L/F Step Risers —
Misc.
SPA Size Area_ Per$
Pump Blower_ 11..0 Spillway_
Jets is Step
Misc.
INTERIOR FINISH PLA sre/P Color W k rt
Other 3 I. A- o -r
A N^b L
C.t -T ► S _
l FooT Te -t S STits ce-ted e� Je.T
OWNER L�o ��� �A lZ ' i /�1 c�
ADDRESS ` jq- d'� `45 K ik0-A
CITYL it ..Dirk OLD BY__ek DATE -f -o
PHONE (H) - (W) 1n
Li
10
DRAWN BY DATE