9907-044 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Gr��pter 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
5i411.,7 A) W31/19!
2" qate r 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.
(';y 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.
f 4454,) -O 1 934
(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=provislons.
.Date: 2-�Z "' f Applicant""%"'
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I
I certify that I have read this application and state that the above information i's
correct. I agree to comply with all City, and State laws relating to the building
constructi(Sn, and hereby authorize representatives of this City to enter upon
the above-mentioned property for Inspection purposes.
i/ ignature (Owner/Agent) y - Date ..
BUILDING PERMIT PERMITp
DATE VALUATION LOT € 90-4f" TRACT
JOB SITE
APN
ADDRESS 79-1.00.K,8VV1VN COFJ. f
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1v NDA NtC4•IOLS
S T E E ':0,DSON C0NSTf� W, I'CO'N
/9-100 KRIM7EN COURT
73011 COUNTRY CLUB DR., Si.rrIT F4
LAQUI.N•TA CA 91.253
PALM DESERT CA !)21260
(76101),M64032 C91,ft 1044
USE OF PERMIT
1?00.L.KNWOt? SPA
fA00L &SIVA.ONLY,- ALARM,'S 3AHWCERS WA7.1.:BE IN PLACE AT
l'k -int. 14iA'k INCL"1.'1C►N. tNv S`i tC3:A'C.IE ►"t+i #i t%ER 1994 U.A.C. ;§
304.5 :FOR WORK ISFCi M W/OUT Ill ii11 (T.
Qv!"AL AND/0R. vPA. 14VII00M LS
A.' 'I'Eo'Rt' TEIY CMTOle CtiNS a RUMON
.14,4f,-0.09
Mi RMIT i? i~;f E iF:fjWTb$AF$Y
PLAN CHECK CK. Fa,' 101.000-439-3.18 $1+05.31)
O')NS17R11C.r►;ON FTT-: 101-000.41.1-000 W11709
ItIrMSTIK:rA"'iOIat:°.. C, I01�000_ 23_000 S16100
,a
2ICCHANICALFTE -- P001, 101-000-421.006.
h:i,EwC:'YRICAL FEE �- POOL 101-000-420-000 $45.0=0
i?WMA XWO F~ -- P00—f 101-000-419.000 $27 (N..)
Si1l3�n1 i4?�F57aUc.:Ts0lNA?°?D?TA»CHECK
j7.530
LESS P,�. �I?AtD FEES
$0,011
RECEIPT !
DATE r
BY /,r e<`
DATE FINALED
INSPECTOR
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
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
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
LEAVE DIRT IF
NECCESSARY
SPA @ +6"
5'-6"
R3'-6"
\ 20'-3" -6"
i
'-3" 3 13'
\\, 11'
13'-3" \
AIRPIPE
R6'-6"
20'6"
15'-3"
BOBCAT ACCESS
NO WALLS YET
R4'-6"
LIGHT SWITCH
RESID
CONTRACTOR cannot assume res on ibili y for GENERAL SPECIFICATIONS
damage to curbs, sidewalks, driveways ement SIZE 15 X 24
slabs, sewers, lawns trees,fences, retaining
walls, sprinklers. telephone lines or shrubs. AREA 263 PERIMETER 64
When access is made through a neighbor's DEPTH 3X5
Property it is understood that you, the owner. TILE CHOICE GROUP 3 55
have that neighbor's permission and assume full RBB, 12'@+6"
responsibility. COPING CANTILEVER
DATE pnni raaArmy 9.000 r.A1
59'6" ■/I
MOTOR HP $TA RITF HP 1.5
NGZDfi mmmmmm"m
FILTER STA RITE 300 SQ FT
FILTER RATE 102 GPM
HEATER LAARS SIZE 250 BTU
TURNOVER 2 HRS
SUCTION LINES 2 it
RETURN LINES 2 "
SKIMMER MODEL AMERICAN
CHECK VALVE YES
GASLINE BY SDC FT. 120
POOL LIGHT 400 W CLOCK T104R
gym=
PLASTER COLOR WHITE
nFrK Ry SDC SO. 400
STEP FT.
SPA SPECS.
DESIGNER SIZE 7 RAISED YES +6"
LITE 100 WATTS
RANDY /EV TRI LEVEL SEATS 22" 24" 27"
DATE DAMWALL 6 " X7 FT.
DAMWALL TOP TILE "
6-3-99 SPILLWAY SIZE 3 "X 12" WIDE
REVISED ISPILLWAY XX OPEN CLOSED
slider#JETS 4 UPER LOW[
(-me:ppCENTURY HOMES/LINDA NICHOLS
G/.E Addressl -/C7C l� ► 5 z L' T.
QoS LA QUINTA
TRACT MARBELLA LOT# 58
ENCL'CITY OF LA QUINTA �4
BUILDING & SAFETY DEPT. 3. ® tisol,
APPROVED
FOR CONSTRUCTION Poo/s
PALM DESERT TEMECULA
DATE BY N 73-011 COUNTRY 28910 RANCHO
��_ CLUB DR. STE F-4 CALIFORNIA RCS.
1/8 —1 SCALE PALM DESERT CA. STE 206
TEMENOTE: LANDSCAPE AND FURNITURE 92260 92590 LA CA.
109
ARE SHOWN FOR ILLUSTRATION (760) 346-4032 2590
��
ONLY AND ARE NOT INCLUDED. _ 091676 -SWIM �,
11!' �F A_C7A1h7 +
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