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0005-129 (RPL)LICENSED CONTRACTOR DECLARATION r'os' ffifm under penalty of perjury that I am licensed under provisions of I )ereby a 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 r, Exp. Date y 1 ��id pate t—T Signature of Contractor-^-< +' l 21--= i,; � f 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 FUND Policy No. 210-00-0019534 (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 pro. isions of Setctlon 3700 of the Labor Code, 6shail fo hwith complywith'thoseProvisions. Applicant Warning: Failure to secure'Workers' C om pensation 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 cons ruction, and hereby authorize representatives of this City to enter .upon th above-mentioned property fo'r inspection;pturposes' {f)[�jfj/ K..r....y % 41X Signature (Owner/Agent) Date s f " s' BUILDING PERMIT PERMIT# DATE VALUATION LOT 0-129 TRACT SJA�W= 266 JOB SITE APN �r ADDRESS 47-M. VIA MOTU.f�wRA 643-,120-0.38 OWNER CONTRACTOR / DESIGNER / EN (NEER CANADAY & C(?WAITY HAL HAW'1'ON offin VACATION PnOM 1570 i3ROMA5L fLOW DRM 301M 108 9522 DONAT"ON RD. 01� I'A.A1•lA CA 92705 LUCERNE VAT,119Y CA 923S6 (909)7.48.6045 Cm 4 335 USE OF PERMIT POOL AND/OR 0PA. ,. POOL ANDD X12 VA 1.4,500.06 LS MM -TOTAL CC3AIS'I RI)MO A'ND PLAN COW.K. n-30 L 03 PRE -PAID •FWD $0.00 TOTIA1, P)3MAff_.Fn15 DAN Now MIX RECEIPT DATE BY DATE FINALED INSPECTOR /1� TIMAUT COST OP C:C3J.�SI'.i�1.JC.•°F ON �'"> �•ik4,�/i9 W -�y�3 +p� Tv�;y�,� py��n7t �•,4 •pH.' ,PFR.t�'id4L FRE �W41SYd1.9'itlR PUNt,''3� CHECK FXE 101.000.439«318 a705.�l0 � " CC NSTRD CTJO14 FEE 101-000-418-000 $dd�.fl0 � 1 r r MECHANICAL F&F. -- POW, 101.000-421-000 `54�•AU ELECTRXAL M. •. POOL 101-000-420-000 9 t�rf � PLUMBING FEY -- ,Pool" 1.01.000.419.000 W1.00 MM -TOTAL CC3AIS'I RI)MO A'ND PLAN COW.K. n-30 L 03 PRE -PAID •FWD $0.00 TOTIA1, P)3MAff_.Fn15 DAN Now MIX RECEIPT DATE BY DATE FINALED INSPECTOR /1� 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 BLOCKWALL APPROVALS POOLS - SPAS 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 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final 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) COMMENTS: '"• tj• LICENSED CONTRACTOR DECLARATION fs.• ' I�hereby atifrm 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 351 ti13 C53 01/31/2( 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: Carrier STATE E 7�UND Policy No 2a9-�d•A0lDw 9 (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 of the Labor Code, I shall forthwith comply with those provisions. Date: Aoolicant 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 forwhose 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 purposes. Signature (Owner/Agent) Date sr •---, r3-��__��., -.x �+% �_--z--.: �- -c-.� _.L ._. �E_ --a....=.rim-i.--...--�..._v:.t�-���r.:•aeref..y'i` 1- i� i..'v. _,-w ..� we. �,... 4: '.. G - `•Yw `'i�c �-..r $. 3F'I 5�r.. 5.�._ ts� BUILDING PERMIT PERMIT# �l-�'►•Z� DATE VALUATION p.y LOT TRACT - JOB SITE APN ADDRESS 47-,73(J VIA MOTT-4MA, s — OWNER CONTRACTOR / DESIGNER / EN (NEER CANAD.&Y & COMPAAi Y'. HAL lfiAltiiYM N dba VACAZON POOLE 1570 DROOKITIOLLOW I)j IV4 SU.=, 208 9522 DONAI'DSON Rp. SAWPA.ANA Chi 92705 LUCET EVALLEY : CA 92356 .(909)248-6045 , . MU3' 4.335 r . USE OF PERMIT POOL, AM/OYt SPA POM. a SPA ON LY -AL ATUASiD AL tt ERS, S11ALL BE N PLACE AT PRE PIASTER 1NSPRCTIO . POOL EQUIPMENT WOLOSURR NOT TWCUIDED 1W THIS PgRMIT POOL AN D/012 SP,M& 1101,504,00 ISS . T tk� F�t t Ez�1X COSTDF CONS'ii1.tUCTI.ON 14,500.00 Pa,JbW.T '." SUMMARY PLAII CI ECK PRE 101-000-439-318 2105.30 CONSTRUCT1014 FEE 101-000.419-000 062.00 MECHANICAL PER -- POOL 101-000-421-000 LST, WTRJC.AL. FEE -e POOL. 101-000<420-000 $4100 1 PLUUM40 FEE -- POOL 101.000-a 19.000 327.00 r .. r ..: 8iAa. ..COTT.1 L CONS .i'.R.U1..1 09 -AN .J PDAN CAECK _ $363.140 . . $0.00 TOTAL PEI?M T 17—ES DUE NOW RECEIPT DATE By DATA IND INSPECTOR �v v i7i� -.'�' -�'�: ..'�'ii V7: ✓ � -.a -.<., if:ti iii 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 Pool Cover Sewer Connection Encapsulation r 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) VACATION POOLS & SPAS 9522 Donaldson Road Lucerne Valley, CA 92356 1A RE-114SP90-PN ff£-OF-$30::1 2413-6045 "WILL BfX�RGEO if -THE APPROVEl3; (760) 248-29 9 fax phone SIS AND JOB CARD ARE NOT ON uc.#C-53-351673 ' THE SITE FOR A SCHEDULED-, Sales Locations LAKE r.. -Bermuda Dunes, Irvine, • 10 California City, Rialto, Lucerne Valley (800) 999-1811 DOCK _ GENERAL SPECIFICATIONS ®F QUINTA CITY O :. BUILDING & S VETY DEPT. APPROVED y 'd' A ' s f ' • y FOR CONS RUCTION '• _ SPA • ' . p --- 5' POOL 3' qd ! a • ' • .•dam • . � ', �.' � �• d' ' ' ' � ,� •: • i WA A- 4 w ;. �• • •. • .': DECK •• • �:. A '. �•� •d• DEPTH ' TILE CHOICE RBB. COPING POOL CAPACITY MOTOR HP MOTOR HP FILTER HEATER S CHECK VALVE GASLINE BY CHEM. FEEDER PLASTER COLOR DECK BY CONTRACTOR cannot assume responsibility for damage to curbs, sidewalks, driveways, cement slabs, sewers, lawns, trees, fences, retaining walls, spnnWers, telephone lines or shrubs. Mihen aocxss is made through a neighbor's property it is understood that you, the owner, have that neighbor's permission and assume full mw sil tidy. . DATE SIGNATURE DATE d!7 / HP HP SQ FT BTU FT LOCK FT SG Name: TvL M b i^00 to- Address: q7-730 Ula /*/oiV. civ: LAA Lt I AJ f 0j v SWM.dwo TRACT:1-0t KC, LOT# ci. &Y AM SPA SPEC SIZE - 7 RAI LITE Y C,S WA DUAL LEVEL SEAT! DAMWALL '" DAMWALL TOP Qu CONTRACTOR cannot assume responsibility for damage to curbs, sidewalks, driveways, cement slabs, sewers, lawns, trees, fences, retaining walls, spnnWers, telephone lines or shrubs. Mihen aocxss is made through a neighbor's property it is understood that you, the owner, have that neighbor's permission and assume full mw sil tidy. . DATE SIGNATURE DATE d!7 / HP HP SQ FT BTU FT LOCK FT SG Name: TvL M b i^00 to- Address: q7-730 Ula /*/oiV. civ: LAA Lt I AJ f 0j v SWM.dwo TRACT:1-0t KC, LOT# ci. &Y AM