9904-060 (BLCK)f
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.
aS
License.#• Lic. Class Exp. Date. xi31./01
ete Signature of Contractor ZY, oety
r
OWNER -BUILDER DECLARATION L
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). t
() 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 thYe work for which this permit is issued.
(� ,))�� I have:and will maintain workers' compensation insurance, as required by
113 c ion 3701) of the Labor Code, for the performance of the work for which this
permitis;issued. My workers' compensation insurance carrier & policy no. are:
Cainen �`' Illl = u'�11 Policy No.;J;^,`I1M1 %3-3i
(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
subje�ct to the workers' compensation provisions of Section 3-00 of the Labor
CoFIe, I shall forthwith comply with those provisio
Late:Applicant t
Warning: Failure to secure Workers omp nsa Ion co er ge 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 186 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
thabove-mentioned property for inspection purposes.
✓Signature (Owner/Agent) Date '
BUILDING
PERMIT y PERMIT4'9
DATE 4/ W'99 VALUATION
2II44)(011 LOT TRACT
JOB SITE -1^ 9114. 11I. fel A AINA
APN ^
ADDRESS
v
OWNER
CONTRACTOR/DESIGNER/ENGINEER
8932. D COMERT'C?}. D
VACAU110M POOLS
47- 90 VSA, ti110N.t'AAIA
9522 Ot33+%ti-L.1)SON ROAD .
LA Q[.)"1N'' A
CA 92253
LUC'EiiNEr VALLEY" CA
92356
t760)248-6045 C13L#
4335
USE OF PERMIT
C.J 1,.9•. 1'O�,t(da1 t f1:Y �1-0i Mg1i47..
4 : L WALL
25.00 LF
1. ,
rl E.a:T
,11VIA i. :D CCWT OF CONSI R1.1(TWIN
C" ONSTRUCl'iflN FEE
101-M-4.18-000 5L.5�1E3
i11c.'17�1fA1,C;ONS^i'1�.t3`TJON,;`1ND PLA3 c:;1 f~C'1:�.
t .f><)
;.FSS PRE -PAID TTES
$0.00
'd
OCAI.. PER10 I Yli+ Eti DIJB;' NOW
RECEIPT
DATE'BY
D E I D
INSPECTOR
INSPECTION RECORD
OPERATION
T
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
_IF
Electric Bond
Footings
Main Drain
Bond Beam
Z
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
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)
GENERAL SPECIFICATIONS
T_
111filliftv Crossectioll
Si_/E
VALI 13X2
............
13
ARE 41, PERIMETEIZ
A
....... ififiniTy
DEPTH
Poo!
concrete
SPA AT
11 wva*,er deckina ![L� CHOICC:
level
4, +,D"
. . . . . . . ........................
........ _-XISTIN p, RB5•
..........
................
... SPA DA.N I ...............
........ G COPING
.... .. WALLSLOP(
Porl CAPACITY GALS
. . . . . . . . . .
2'; pool
. . . . .
PUVP CAPACITY GPM
II -
. . . . . . . . . . . . . . .....
-OR HP
MO ST. A RME_ H P
-DOCK ------- -------- --------
5'min. MOTOR HP
HP
to FILTER STA RITE 300 SQ FT
FILTER RATE J'02 GPM
A
)AT DOCK HEATER LA."U SIZE BTU
STA I SL TO 13, OJ�T INFINITY EDGE
NO -
FEs TUR ER HRS
SLOPE
: - . WIN L -SUCTION LINES
_UjJRN LltJES fI
QTAC='QU ZITE cc
AR Y7 rn
N m
94 SKIMMER MOD I
IrrT-- CC
la CHEQ
-K VALVE
C10- GASLINE BY FT.
400 W CL DCIK
ro 7 OF CAS
POOL LIGHT
E JR L BY.
L E: ICA
:a
• AIAE
A! Cr.
CHEIA. FEEDER
PLASTER, COLOR
LA,
_ _ " ': - f ^ 4 �..
T
DECK BY"
DECK TYPE SQ
STEP FT.
SPA !SPECS.
7
NT
LA QUIN A
SIZE RAISED.
-----------
- AtDEPARTENT LITE 100 "-`ATTS'
M
TRI V.1: I NALLY
LEVEL SEATS 2211 241, 27"
DESIUAMWALL X FT.
GNER
DANNALL TOP ONSTRUCTION'
IONAS PER SPILLWAY SIZE X WIDE -
-DAIT�, SPILLWAY OPEN CLOSED
US OPER LOWER
1 BBQ CEI TER
1 ,al, - ':: I 1A LICABLE CODES Name- COl4ERFORD
Addre.-,.s:
f,Z A) q
BY City. LA QUINTA
TRACT LLQ LOT# 269
Z
L
Vacation ]Pools
FR
RESIDENCE UCENSE NO C-53-351673
9522 Donaldson Road
NOTE: Lucerne Valley, CA 92356
LAN
'DSCAPE AND FURNITURE 760--248-6D45
ARE SHOWN FOR ILLUSTRATION Fax 760-248-2919
CYNTLY AND ARVs NOT INCLUDED,