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9704-106 (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 / 118°947 C;-13 M.31198 `w. P. w 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: Cartier Policy No. C3+.^i.i;�)sIJ'.irti�:ji.� , Fti'�`�,''�.•t�i(tt (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 manne . so as to become subject to the workers' compensation laws of California, an . agree that if I •should become subject .to the workers' compensation provisions of SectiQm 3700 of the Labor Code, I gall fo hwith comply wit "tho§e provislo�t ,date: ,�4 Applicant_��l ' VA 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 f application. e 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. t. 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 p rpose . t �gnature (Owner/Agent) v - �� Date 14 PERMIT# CONTROL# BUILDING PERMIT 704-16 5040 DATE 2-�� VALUATION �i,d�� LOT' TRACT JOB SITEAPN ADDRESS 794" LADERA i'IKIVE ' OWNER CONTRACTOR / DESIGNER / ENGINEER OL(?C)MQ>✓ 91' MA.9:1.I.11 POOLS 79-.19.1:[ADEi A DR n-555 E3iCij:•!th AY 111 I., ! (�l.Ji?lei 'A �'��, 9 253 'PA JAW .O Sht'107 C .A S�Z2'0 USE OF PERMIT ji(>Oi� ANO SPA (iNLY •• 1, 4 9A1'1M1?,!) C091" Or' CUNSTaRVMI4r,,iN 1..10 4i�iif E PKIMUI' FCC' NWIUli'i'ARY PLAN (111ECK kt-? 10I -©W,439-318 199.45 )`.t^t, 1:9 fO ,itf li�i CCt1Lt`R. -- .C-' KA, Efl't -t2l. ODU $2-10s 111LI1.CT_fW_%1tN11.1 ITIsa _POOL, 1riI-G1044,t)? 000 :914 06 r`u)mlilNo1,•"it3....w.xx' 1171-tVD-419•000 $2740 • � X94 ff . t 11"'.�3i, 4COI;?S'IvR:R7:�1`[0NANDP!,ANC CTI I IR!�JR45 ,SS � '-VAILI PERS .c)c) APR 2.5 1997 T0; "At PERIIIII$a,e NOW $34NA5 CITY OF_1A_ WNTA �. . JRECEIPT DATE . QY 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 Wali 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 Pibg. 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) mum _V021111M , SPECIFICATIONS i Size Iia Volume Gallons, i Template NoShape Surface-_ 114.1 Perimeter � - UF. Depth s:M ni um . Maximum _Break j:. Spa size. Volume ..- Gallons. EXCAVATION Finish Elevation Method: Access :;_Site Preparation Grading Dirt Removal/Loads to Dump Dry well Location. Fence By fX!-_S_r-Mate a - Size ofOpening------------ NOTE- enin--------_ Cdtpf�'.�LiGlSlfaA� , P g - NOTE: No painting or matching of texture will be done! PLUMBING n Filter Type-�-x • i�T ! i QC� Size Pump Type 1L _-Size --� 15 Skimmer Type `_ii��_- r -Size - .- Heater Type_-_�_ __�__ Site Heater vent a -- Jet Pump Type--------- Blower ype--.-_- Blower Type_ -Size _.- /Plt Equipment Location -- PIC Slab Plumbing Material ___C _ - I� Suction: Size __ .- Length Ft. Discharge Size L n____feet. I Waste Tci___^— -__ _Size Feet. Returns in Pool. Number _ ize-- ---Length __ Feet., Return Inlet Type Fill Line (with Np Obstructions)Size--Lyth __. F1. A/S Valve Location' ✓ Gas Line By Size�- ILength 'Feet: Automatic Cleaning - 1 UTK;; ? - -'SPAINFURMAiION_-- 1 F .-- e t Suction: Size .--J..gth: � Ft. Drscng.5ize > L,Ith _ 2 Jet Type__ - Number _;6/ Jet Air Line Number ----Size _ Length_._ :Feet±