9804-084 (RPL)LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of tN6'Business and
W Professionals Code, and my License is in full force and effect.
,M License # Lic. Class Exp. Date
Lii 'fl
W n• h' ' l
b1�7 A•
II r
Z � a- Signature of Contractor -�
Q. rll� .
U � OWNER -BUILDER DECLARATION
W r– I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
Z I hereby affirm under penalty of perjury one of the following declarations:
p () 1 have and'will maintain a certificate of consent to self -insure for workers'
W L= compensation, as provided for by Section 3700 of the Labor Code, for the
Qperformance of the work for which this permit is issued.
Q C) ( I have and will maintain workers' compensation insurance, as required by
U Section 3700 of the Labor Code, for the performance of the work for which this
LO H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
cb Z)
Cf STATE FUND 1242679-97
(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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I,shall forthwith comply wi #5 those provisions t
Date: !'7Applicant –1713—
Warning:
71 Warning: Failure to secure Workers' CompensStion 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 i&.hereby made to the Director of Building and Safety
for a permit subject to the' conditions and restrictions set forth -on his
application. j
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 proayf, spec04tion purposRl":
\Sig ature' (Owner/Agent) Date
.q ... 4 ...y, ¢,}xq• a�^� M1`�.n M,_ .f.' Y.. s.j'--1 J.r, c•i«Y..;:.d';,'�.
w'
BUILDINGPERMIT PERMIT# CONTROL#
DATE / f VALUATION_ LOT 98"084 TRACT a¢
®`'
/1.1-y d !%r � S2S�d1ti0.011
JOB SIT .,
APN '
ADDRESS
47-520 VIA MON ➢ DANA
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DON f3ROWNE
STEVE DODSO.N CONSTRUCTION
47,520 VIA MONTANIA.
73-011 COUNTRY CLUB DRIVE, -S'T'S. F4
LA QU1NTA CA. 92253.
PALM DESERT CA 92260
7 0)3=16-�l03? i CE3L� E(i4 !
USE OF PERMIT
POOL
POOL/SPA ONLY, ALARMS/BARRIERS ARE TO HE OMtA'i ZONAL PRIORAID
TO EN-CAPIPRE-PLASTER (NSPECTION
'POOL ANWOR SPA 25,000.00 Ls ATY OF
LA QUINTA
�q
ESTfMA►TE D COST O!I CONSTRUCTION
2.5,000.401
PERMIT FEE SUMMARY
PLAN CHECK,M_ 101 -Wk -439-318 €1630)
CONSTRUCTION FEE 101-000-418-'000 $252.00
MECHANICAL F E -- POQL 101-000-421-000 -Sti4.00
aEC. r.R1CAL FFE, -- POOL 101-000420-040 S45.00
(PLUMB M0 FE -- POOL 101-000-11.9-000 $Y/0)
SUB -TOTAL CONFIRUCrION AND PLAN CHECK
$511.80
LESS ME, -.P,AI.D FEES
$0.00
TOTAL PERMIT FEES ?DUE NOW
$511.80
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
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
7
Gas Test
Appliances
41
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
Tamp. Use of Power
L
FiW
Utility Notice (Perm)
RT
DOCK
QQNIRA_C79R ann9t_asau-m-e.r_esp-onsibilit_y-tof GENERAL SPECIFICATIONS
LAKE FRONT' d.amage-to.cur side_vralks, driveeway-s,�-ement
jslabs s-evv_er_sJa-wnsstnees.�ac-es� retaini.ng SIZE 15'X30'
,.. :�r�i�c�na fi��sr.onr. deckingt
waI sprinklers t-ekoDne_lines_ox-shrsa.lis AREA 350 PERIMETER 80
2 SHEER DESCBTS FOUNTAINS-' - f 46EE) SPA AT ,08" Whenac-cessj=adethro-Ltglianeighb-r'sDEPTH 3'X5'
ptonerty_it�s�nd_ets�oo-i:Lthati_y9u—tb-e-0-wner, TILE CHOICE GROUP3
# rniss�Qa full
ry baYethat_nei.ghb9r aper _ aad_asssam_e_
BBS "
res: Qnsibiky
;.. COPING. CANTILEVER
freestanding wall to DATE _—_- si nature D1L CAPACITY 12 000
GAL
rrt PUMP CAPACITY 103 GPM
RFS' i
�,lI�IIP��MOTOR HP TA RITE 1.5
,..... .
MOTOR HP .................... HP
FILTER STA RITE 300 SQ FT
EILTER RATE ;102 GPM
i�
3� HEATER LAAR SIZE 400. i
TI Ind Il\• •rr• n
WITCH