9803-062 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Se :ion 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
9
N5 C53 C2.13. 6130/98
Date Signature of Contractor - IL
�
OWNER -BUILDER DECLARATIQN
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 sectiori need not be completed if the permit valuation is for $100AO 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 sfi `fofrthwith comply with rlioserjovisions�.-.
Date:4 ; 6 s Applicant -
Warning: Failure to secure Workers' Comp ensa�dn coverage is unlawtul 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 propert o ' spection purposes.
f -
Signature (Owner/Agent)__-_- f .� '' Date
BUILDINGPERMIT PERMIT# °°NTRDLN
DATE VALUATION LOT 9803"062 TRACT
4-3- $13,000.00 86.3.2
JOB SITE APN
ADDRESS
79-135.KRISTlEN COURT
OWNER CONTRACTOR / DESIGNER / ENGINEER
CEly rURY CROWELL COMMUNITIES
15.35 SO. "'D" S"1REET, STC'E. #200
SAN BERNARDINO CA 92408
USE OF PERMIT
DA7X PALM ENTERPRISES
74818 VE1.,1E WAY #6
PALM DESERT CA 92260
(760)346-2504 CHL# 1868
i
POOLJS`PA ONLY, ALARMS/BARRMRS ARES TO BE OPERATIONAL PRIOR
'r0.h-N-CAP/PRR,PLASTFR rNSPFC`r1OX Ir, A
POOL AND/OR SPA
PE'R111LT FRE SUMMARY
PLAN, CHECK FEE,
CONS1RUCTION F:E) ,
Y�f ,CHANfCAL �7 ER -- POOL
ELEC 1RI.CAL FEE -- POOL
PLUNIBINGFFY, -" POOL
13,000.01) .Ls . APR
CITY OF
3 1998
A QUINTA
i
i t
.1:%,I11D0.�1
/
SULK-TDTAL CONSTRUCTION AND PLAN CHECK $333.60
LESS YRIE-P.AID FERS
TOTAL PERMIT IFEkS DUE NOW $333.60
RECEIPT DATE . BY DATE FINALED INSPECTOR
W -
101-000-4:39-318
$93.60
101-000-418-000
$144.00
101.<000-�#�.1-000
��.Oi1
101-000420-000
$45.00
1014000-419-000
$27.00
3 1998
A QUINTA
i
i t
.1:%,I11D0.�1
/
SULK-TDTAL CONSTRUCTION AND PLAN CHECK $333.60
LESS YRIE-P.AID FERS
TOTAL PERMIT IFEkS DUE NOW $333.60
RECEIPT DATE . BY 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
eo%of Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
•44sulation
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 10
PLUMBING APPROVALS
Gas Test V
1z
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 10
Sewer Connection
Encapsulation Q —
Gas Piping
Gas Test
Appliances
{
Final j
COMMENTS:
wr
7T
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
(sinal
4'81ity Notice (Perm)
A qlt Of
7�w
.� L
r �A
1 1
Pts o
`7 -135 T
. ��... Y
60
rl
i ..
• 4
d s
�W V
.e
r�
..r-.^.... ter.... __..i r.—.. _. ir. ........ r_... .. ... ..r...u..� r.. ..
* --.__....._..._.._...___..._._._._._._......_..._�....r..`....,......_--- Y._....._._ .. .... .... _..._.�._. _._____.__...._____. �.,�..__.�. .....-..--._ -� • :1;. ,..f.„:`'.::,..;�.-•,tk: ^*•:.:Y..c`
POOL AREA SCALE 1/8" 1'„
PLOT PLAN -NO -SCALE
�
1 .
hi t f
.
s
POOL SIZE DEPTH TO5 TZ, 75 PER
SO. FT.
13 INCLUDED
w
}
TEMPL. NO. FILTER NO. _,912 j NOTE:
��T 1�� %�
SHALLOW END,
.. CI
I I LADDER ...... ❑
SHAPE �C-NO. RETURN LINES
DEEP END DIG--.
P
...' .. ❑
❑
f SUDS ❑
IN SPA �(1Yi' ❑
ACCESS FT. FENCE b�d-cJ
-TRAP ...........
BACKWASHUNE
:.... ❑
LIGHT
SPA V.Sa .. ❑
MOTOR PUivP :t HP �
VJU
.: )G �Gr�i I l �l')'1 E:' I�t� f"� �+1--
FILL LINE .........
❑
C-LORINATOR
LIGHT-zANTISYPHON YES A -0_n
P 616V T L A) mile, ;
GRADING .........
HEATER a00tCZ0..
❑
0.'
ROPE RINGS ... ❑
MAINT. KIT ..... ❑
ELECTRICALFT. BONDING YES _3b
L>64!s ITW A) i , �1L L1 D
GUNITE INSP .......
❑
�, TREES ....... ❑
,
GAS L� FT. TILE 20 COPING NO. OAAXr 7600-IABOARD
..........
CJ
{ 1 OTHER ....... ❑
i ' 1:
DATE PALM ENTERPRISES
/
C�
OWNER �� t_ 11
��1`7-
POOL/SPA CONSTRUCTION/LANDSCAPING
TRACT �'Y�l�etJl�i
JOBADDRESS
!
x�tivr
nwPNo.
(760) 346-2504
Z
C"LCA
JOB PHONE
BUS.
PHONE
CONTRACTOR NO. B -1;C -53;G27 690775
SALESMAN ✓r PLANNo•�-
JOB NO.
i
• �=;.
°:r:�:
_:Tn