0005-127 (RPL)I.Wil LICENSED CONTRACTOR DECLARATION
I hereat' affirm under penalty of perjury that I am licensed under provisions of
Chapter 9A(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
�gs3te�J .� Signature of Contractor�;�
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).
() 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_ b"P11.14TE FUND Policy No. 229-004*0334
(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 tithe Labor
Code, I shall forthwith comply with those;p;rovisions.
)Date: CZ��;Applicant�s-""'n �.. _ ,� R
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 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 property for//inspection purpose "s
IS gC nature (Owner/Agent) H w�T r°� _•- .k:7 Date r . "!�1
-�a -� ` BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0005-127 TRACT
5145=00 266
JOB. SITEAPN
ADDRESS 47-610 WA MOATTAN .A
643-120-038
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CMADAY & COMPANY
HALiAN MX- H c%a VACATION Pf301..q
1570 BROOKHOLLOW DRIVE, 9131TE 208
9522 DONALDSON RD,
SANT'AANA CA 92705
Y UCIME VALLEY CA 92356
(909)248-6045 CBU 43435
35
USE OF PERMIT
POOL AND/OR SPA
MEU-:.Y-J.A.7y R3QA WT 266. PERM LT "%1S?T_.f1dVT� Il�•Ai;[�CK Q
}lf r4?i1�-'C� C� I �- �� G " _. 1�c„� S / 1 ` GAJ SL:. U J e // 1--� c._+_.
�✓
f> \
POOL AND1OR SPA 14500.00 W'
ESItTKI) COyr OF Fi",C N,11IRt:iCrI:ON
1
1 Wrr �
,
PLM CHECK FEE 101-000-439-318 1!05,30
�••� 4 >;.1 �`µx
CONSTRUCTION Mt, 101-000-418-000 I116�a4
��� �tI � '•
MRCM4110AL FEE -- POOL 101.000-421-000
tit PlCTaICAL, FEE e. POOL 101-000-420-000 WAD
PLUMBING PKK-- POOL 101.000-419.000 $27.00
-
SUR, -TOTAL CON ;U'CIiON' AND PLAN CHECK
S-363.30
LESS PRE-PAYDS
$Q100
RECEIPT
DATE
B�I e `
4 l��J
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation '
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Footings �� �b -,
Electric Bond
Main Drain
Approval to Cover
Bond Beam
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
_
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit _
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
< Jka f5
fa
�4. A VACATION POOLS
s,rt RE INSPECTIONS :FEF =�
+ � � WILL BE CHARGED IF THE AppRp�30 9522 Donaldson sort Road .
APPROVED' Lucerne Valle CA 92356
PLANS AND JOB CARD ARE
` M a
760 248-6045 hone ;
NOT ON � ) phoneTHE SITE FOR ,SCS. {760) 248-2919. fax
r f��
t 1_INSPECTION,_----
.NO Lic.fC-53-351673
EXCEPTIONSI. Sales Lo c a ions F
—. Bermuda Dunes, Irvine,
LkKE-, --- Ca famic Clfi , Rialto,
Lucerne Valley
P;g..1
0 999-1811
GENERAL SPECIFICATIONS -�
=
Doc1{ . • CITY OF LA QUINTA IZE.'
AREAPERIMETER
BUILDING & SAFETY DEPT.-- -_,..... _.
-
t DEPTH.._..
P OVED ,H _
AP TILE CHOICE _._..SQ
• - • ' • FOR CON TRLICTION
C A -TCN B )qs'.zN_
COPING
PACITY . _ . GALS -
DATE Qgy
HP POOL C
i_llOTOR H _
�N �. n>_,`% ��5 e LUOTOR HP o2 HP
I$cl S ��. 2.-O �•.
C.FILTER a-+� _3oa-SQ FT
38 t HEAl'ER SLR S1ZE..`oa BTU
!CHECK VALVE - -... ..:.. .
_ - GASUNE 9Y _ U, -P _ FT ML I
1001. LIGHT �� - `., ; -�_ _ •• .. r---• z,00
CLOCK � -
. i4 .. •.� • � �-`EL.ECTRICAL BY FT
AUTO _ CLEANER-
_ DECK CMEN. FEEDER---- - - -- _
R COLOR _ �-
4 �_ (� DECK 8Y _ e.• -s SQ
-4 , • ' r. ;. y • ;� ; �: 1�1 QECK TYPE _. _. __.0 .
STEP _ Fr. -
A a L__�I SPA SPECS, ..... - -
w
�- SIZE 7...'_- RAISED
w.,. PSS
o
LITEy WATTS T ! o
oluI.- �.EVE>. sEa►rs a
DAMWALL
` DANWALLTOP T-) ie_
SPILLWAY'--- - -- -- -- Via;; •X %8u,� ---
SIZE
SPILLWAY
CONTRACTOR cannot assume responsibility for I DATE
(— Ov �� damage to' curbs, sidewalks, driveways, cement r---- -#JETS
stabs, sewers,. lawns, trees, fences, retgining wallet • ' _ ... ... _ .
sprinklers, telephone Ones** or shrubs.
Q
Q N me: 0
n
t✓ When access is made through o neighbor's property G GY lit. 7t
It is understood that you, the owner, hove_ that
net hbor's ermission and assume full r onsibir Address: u %r10A)
4 P �P tY• -T ? % 70 V
/+ .O T City'e.
=DATE '
r -- ..... VPs000a.d,. TRACT: _kKe. e. L• 4. LOT' OL Cv6,
• `�- - _ SIGNATURE .. , . .9 �