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0006-218 (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 ExpDate .17412 A � ;�" 0it/31/2f, , r mate Gj �'1 Signature of Contractor v+ / 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 STATE FLING Policy,No, 0463 00 000W34 (This section need not be completed if the permit valuation is for $100.00 or less). ( ). •1 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 ofjSection 3700 of the Labor Codg shall forthwith comply with t osetp�ovisions. �e: Applicant �i��i Warning: Failure to secure Workers' Compensation coverage is unlawful and `f 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, anq State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. / Si nature (Owner/Agent) fY` C ” 'W..-.� Date BUILDING PERMIT PERMIT# t - DATE VALUATION LOT OW6--2g8 TRACT '21,690M JOB SITE ? APN ADDRESS 7 nonnuor` OWNER CONTRACTOR / DESIGNER / ENGINEER d ERIC! JA;.CKMM WVE4'E DODSON C ON'3Mi3MIOX WL. 79-820 HORMSHOF1 ROAD 730911 COUNIT(Y CLUB DIL, 'DUEM F4 t QUINTA CA 92233 PALM D1r,.S'1:'Rl CA 92260 (760)346.4032 CBLIf 1044 USE OF PERMIT P00+1, AN'DIOR SPA k IDOL &_ SPA ONLY.AL.6.:f;MftARRIERS SHALL P49 IN PLACE AT FIR&P AR t ER INSPECTION. BLOCK WALL FOR POOL EQUIPMENT ENCLOSURE IS 140T INCLUDED 1N THIS PERMIT VALUAT104, k 4 _ ..;16�I9:A0 L-3 SUB-lfOTAL CON`SDRU'i�"j ON A1�_ PIMM i1=, 1`K X67.2.3 W03 PRE -PAID T * � TMA34 ' fYff.S1) 9;IX!V0W $467,25 RECEIPT DATE r-^ BY ,'/� I DATE FINALED INSPECTOR ramxmC'C1w Or OUmmT3cnoll 21,t M00 4 P vVr FIX GA Y 8 PIAN CHECK FUE 101.0900.439.31 _ -t� 51405 CONSTRUCTION FEE i 0 i -ate -di B-tIC� �aa�.c� MECHANICALMS •- POOL 101.0700»421-000 E1.ZCTRICAL FU ., POOL. 101-,000420-000 Iu3S. flfl PI. UMBI:NG FEE -- POOL 10i;000-419-000 $27.00 ,rte+ SUB-lfOTAL CON`SDRU'i�"j ON A1�_ PIMM i1=, 1`K X67.2.3 W03 PRE -PAID T * � TMA34 ' fYff.S1) 9;IX!V0W $467,25 RECEIPT DATE r-^ BY ,'/� I 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 8 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 q Footings Main Drain Bond Beam I Approval to Cover _ Equipment Location Underground Electric Underground Plbg. Test -c 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 Sewer Connection Gas Piping Pool Cover Encapsulation Gas Test Appliances Final 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 0 Final Utility Notice (Perm) AIRPIPE 14 frg•�1_1 5-W A7. 18'x• - - - -- -Y LJ - 77 � 181.41 9 ­. ' T • . 3&-W BENCH - 37 IC1 3 -- Y / Y-6- •..�9 BENCH ----------� I Lf 1 1 1 1 l 1 DECD DRAtti 1 ' 1 EJOSTING PATIO 1`, 1 Y. 1 i E RESIDENCE r SR & SPUN SPA VERTICAL A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. .NO EXCEPTIONS! GOLF COURSE ACCESS PLANTER .18•HIGH PLANTER WAIS. 1 3S \ ( . 1 1 1 BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUC:TION DATE z_ / C-:0 LIGHT SWITCH SPA SPECS. DESIGNER ISIZE 7 -RAISED ♦18• RA\DY+E llfE 100 WATTS_ ADD VENT STACK 130i10 TO HEATER RfiVISF� G _ srZ =—X'37 .1 I � _657_ PERMETER I_1 � When aQesR n md, thmIIph a nelahh.n•s DEPTH 3\S C 'scion TgE U10 c1 GROU _ Sn 9y _ _ Z hIIY4]LaiOGID6bo{5 tae aM 1 ha �, IS�_a(B_ I . _ CA`TILEVFR- signatuR PQQL.CM4L(MY_ _19.710 SAS_ t N P �CffY I�LWI m PALM DESERT TEMECULA _ MOTOR HP STA RITE H 1.5 G . 73-011 COUNTRY 28910 RANCID FILTER _STA RRE 300 Ff 0 . 81LIE nT 102 GPM •• ONLY AND ARE NOT INCLUDED. LIEpAIVEtR-LAA S WE 400 _x- m `MVV R Ham- ;CTIIN!-UNES W YI_ _ 3 - SISIMM MOOEl AMERICgN ' CIECIS.VALVE_ YES_ d ASUNE GBY SDC FT. ALL O d POOL UGHT 400 W CLOCK T104R N ELECTRIU4L BY. SDC cT Ate- O PL A - Z T g O DfCKBY 673 O r DECK TYPE SLT FTGSH SD BUFF N LIGHT SWITCH SPA SPECS. DESIGNER ISIZE 7 -RAISED ♦18• RA\DY+E llfE 100 WATTS_ ADD VENT STACK 130i10 TO HEATER RfiVISF� G ERIC JACKMAN .1 I � � I o CONNECT SrDEWALK Ad&SL 79-820 HORSESHOE RD G TG DRIVEWAY SD : LA QUTA �N W A Y T1I��QNMM SPRINGS m U, N Pods PALM DESERT TEMECULA N 73-011 COUNTRY 28910 RANCID 1/8"=1' $CAIS CLUB DR. STE F-4 CALFORNIA RD. PALM DESERT CA. STE 206 92260 TE►ECULA CA. _ NOTE: LANDSCAPE Alm FURNITURE ARE SHOWN FOR ILLUSTRATION LU 34C 4077 92590 ONLY AND ARE NOT INCLUDED. I PC (Q 076-swiN T Q W STRIP FORMS FOR FINISH STUCCO TO MATCH HOUSE DOUBLE CA,►.NTILEVER CAP — AIRPIPE 5-0" T-0" 8'-3" 1 M [hh N -,A!!! ..!FAA S BENCH 37' 10' 25' rt ASS Rl OCK m nvF oaMwa� WAI I PDQprroperty 21 6'-6" P/ 21 0' 5 30'-0" 2�, �1 3'-6"I GOLF COURSE ACCESS EEVE PLANTER +18" HIGH PLANTER WALL 401-0" CONTRACTOR cannot ass� resgonsibili y for damage to curbs, sidewalks, driveways. _cement slabs, sewers, lawns,trees, fences, retaining walls,sprinklers. telephone lines or shrubs. When access is made through a neighbor's it is understood that you, the owner. have that neighbor's permission and assume full signature REVISION ALERT (STUCCO VENEER ON SPA) P/L GENERAL SPECIFICATIONS SIZE 22X 37 AREA 657 PERIMETER 121, DEPTH 3X5 TILE CHOICE GROUP 3 SQ. 94 RBB15'@+18", COPING CANTILEVER POOL CAPACITY 19,710 GALS PUMP CAPACITY 103 GPM MOTOR HP STA RITEHP 1.5 "IM 19 WNW FILTER STA RffE 300 SQ FT FILTER RATE 102 GPM HEATER goo BTU TURNOVER 2 HRS SUCTION LINES 2 " RETURN LINES 2 " SKIMMER MODEL AMERICAN I. CHECK VALVE YES GASLINE BY SDC FT. ALL POOL LIGHT 400 W CLOCK T104R ELECTRICAL BY. SDC Fr. ALL AUTO 12' I I DECO DRAIN 1 EXISTING PATIO 1 'I I, I LI 1 35' LIGHT SWITCH ADD VENT STACK TO HEATER G E © 51-6" o CONNECT SIDEWALK ' RESIDENCE TO DRIVEWAY so' C F bUINTABUILDING & SAFETY . A RE -INSPECTION FEE OF $30 DEPT WILL BE CHARGED IF THE APPROVED APPRpVEpRUCT PLANS AND 10B CARD ARE NOT ON FOR CONSTT THE SITE FOR A SCHEDULED ION INSPECTION. N .NO EXCEPTIONS! - DATE ��"'� /8"=1' SCALE NOTE: LANDSCAPE ANDFURNITURE ARE SHOWN FOR ILLUSTRATION ONLY AND ARE NOT INCLUDED. Name: ERIC JACKMAN Address: 79-820 HORSESHOE RD Ci )L LA QUINTA TR�ivDIAN SPRINGS LOT* Db son Poo/s PALM DESERT TEMECULA 73-011 COUNTRY 28910 RANCHO CLUB DR. STE F-4 CALIFORNIA RD. PALM DESERT CA. STE 206 92260 TEMECULA CA. (7Fi(11 346403? 92590 (90 )676 -SWIM i it it e_rs'4_S7ai 27 r PLASTER COLOR WHITE DECK BY SDC SQ. 673 DECK TYPE SLT FNSH SD BUFF STEP FT. SPA SPECS. DESIGNER SIZE 7 RAISED +18" RANDY/E LITE 100 WATTS RI LEVEL SEATS 22" 24" 27" DATE DAMWALL 12" X 10 FT. 5-30-00 DAMWALL TOP TILE of SPILLWAY SIZE 3 "X 12" WIDE REVISED SPILLWAY XX OPEN CLOSED 6-19-00 # JETS 4 UPER LOWER Name: ERIC JACKMAN Address: 79-820 HORSESHOE RD Ci )L LA QUINTA TR�ivDIAN SPRINGS LOT* Db son Poo/s PALM DESERT TEMECULA 73-011 COUNTRY 28910 RANCHO CLUB DR. STE F-4 CALIFORNIA RD. PALM DESERT CA. STE 206 92260 TEMECULA CA. (7Fi(11 346403? 92590 (90 )676 -SWIM i it it e_rs'4_S7ai 27 r