0301-220 (RPL)LICENSED CC; T'T TOR DECLARATION
I hereby affirm under penalty of perjury�`i� iat 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 ej Exp. Date
Date Y - i ` 2Signature of Contra tor' '° f �' A
OWNER -BUILDER DECLARATION %�
I hereby affirm under penalty of perjury that I am exempt from the Contrac" torts
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 STATE FUND Policy No. 017316.00
(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, aqd agree';hat if I should become
subject to the workers' compe sn ation provitions of Section 3700 of the Labor
Code, shalljf,o th 'th complywith°those•p �isions"'� � �1 `
Date: Applrlcan4t'�`%'� a !
Warning: Failure to secure Workers' Compensation cov . ag, 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 iithpll�City,�alld State laws relating to the building` -
construction, and herebly�author))ze r presentatives of this City to enter upon
the above-mentioned pr perty fdr inctio purposes.
. /J,n IgM
Signature (Owneir//Agent € ' 't • DateF l
W' yy . i ;P
BUILDING PERMIT PERMITN
DATEVALUATION $1.9a.300 LOT TRACT
�-
ADDRESS '��S, -'/RVM- `i alltCLE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LARMY C3u1 fo_-lia
50R44I£{.V0OU
78485 InMW CIR M.E
p.0, Ell (")X 833
LA+�1U.WTA CA 92253
p
;
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
steel
POOLS - SPA
Set Backs
Electric Bond
Footings
Bond Beam
Main Drain
Approval to Cover
2
Equipment Location
Underground Electric
Underground Plbg. Test
D
4Final
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
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:
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
397252 C53 I Wl/V
Date
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.
( ) 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 SR A'1',L 17i)NL) Policy No. 0519316-00
(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. :f
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance ofvsuch
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0. 01-2.20 TRACT
JOB SITE't�^q�.Ty
APN
ADDRESS '�'tt,I,^ ," ItZ 1.Y F.;�i e .
OWNER
CONTRACTOR / DESIGNER / EN (NEER
:1-10, Y 06,YGIFY
SWAM P00.1A
Z.,ekQMr):A CA, 9'; 21:5
IyALiJ_d9?E.�i}I T Ck 92761
(619)6801 L#F 29
USE OF PERMIT
POOL AS MWOARAVA
PC*L, SP.A, A,tAK1.65 8ARR1Zk1S TQ BF, )NI PLACE @ PRX.t,l. STorb
D111PEC'C aK EQUIPMENT ENCLO.TU t.E.14W DICLUlDit D
Pt' OLA NDIOR SPA 191300100 La
Ia TBI)' ST Or CONSTRUCTION
�j f$ �}� �rwyryJ '[.���ja7"
WER
PLA CH K.F 101.000.439.318 Li3�;,a9
CONSTRvt"7100 Ft?',1: 101-000-41 8-000 $20,00
Y
1Ve HANK. FFZ , POOL 101 -WO -421-000 -4211.000 MOD
Et,t?,C9'iUCA1, YBE -- POO1, 10'3 «00"20.000 .fJt3
k'Xei1W3CHO,te y.;._ POOL 101-000.41.5.000 WIN
33)f '%r1 °AT. COWI'' IC'1'.T€: NA PLAN CHM
. ZI)$ PRE -PAID VF-�:S
,0f3
TOTALYERAWT FM DUE NOW
Y
5437,Z5
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
3-- 'r 0 3
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
Set Backs
steel
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
�D?✓
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
/ p
COMMENTS:
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)
1
PLOT PLAN
GENERAL SPECIFICATIONS
y
Size /7 x 3Z_ Code SO -36 S
shape LV 5 y b-yw
Vacuum Line & Skimmer "
Depth ? to `2 2 tD
�-
Tikr Cola (Q 0,12 -Ir
Backwash to $
Coping 12" 'fT Car bw'-er
4 fi s
Pool qty 12- o o 4
Gals.
ro
Pump Capacity q O
G.P.M.
Filter V 12X -Y C_ t L 0
sq. Ft.
Pump Wx." S H.P.
Filler Reteq.;--
G.P.M.
.
- Av' k
Oo A
VVVL
Tiunoyer Hrs.
Vacuum Line & Skimmer "
Retwn Line
Main Drain
Skimmer �M `✓bF✓L- 1- '
Backwash to $
Anti -Syphon Valve
Heabr LiQ-v4+LS Size 2--s-400.--- &T.U.
Goline by 6 V A,,*. j, Electric by
Ugm �-6Ay v✓ /.- Vo o of
Time dock T / 0 -vi,. -AL "*
Board �— Color
slide - caa
l4w, 0 � , / Q3 BY+r+..wwrrrr. ENp a
�•r f�
s SHALLOW
J END,
SCALE Ilr - 1'T
�wapt-v1►�� -
14 t9wA -5-tt S4;94,
696 C^4—
Name
Address 7`$ 7 S S __r 12 W t N C L'W ,
city 4- Vv,
Cross Streets N. .!
Phone_,