0005-130 (RPL)LICENSED CONTRACTOR DECLARATION
I Ii�reby affirm�ynder penalty of perjury that I am licensed under provisions of
Chaptea 9 (comALIQ
ncing 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
/ 351673. C53 Ol./9112C
/1
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 I 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 S' ATS FUM) Policy No. -229-00-0039334.
(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
sh
de
O, I lth comply wits those provisions -7-1
1
Date: � Applicant t:.,�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to cr!rrninal 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 purposes.
i nature (Owner/Agent) 1,,_• \
.Date ✓•
BUILDING PERMIT PERMIT# J
ATE VALUATION LOT 000& 1 3(l TRACT
$14,55=00 2"
JOB SITE APN
ADDRESS 47-735M 11f1.OMA1NA I 643-120-M
OWNER ICONTRACTOR / DESIGNER /
CMADA`'!` & C011WANY mL Hfiavw ON dba t,mmiow POOLS
1570 F:RO,1O1010- MOW TDRML., Rrr'x; 208 9522 DONALDSON RD.
SAKfAANA CA 92705 LUCK VALL2-Y CA 92356
(909)248.6045 aBL O 4335
USE OF PERMIT
POOL A?dT9IOR SPA,.
r.
3#�3—iAAX3�3F3�.OE' ebb--:PP3-f313aE3'wjtd04.
i#�i(}?C?Cj S—�--
POOLANEWOL1 SPA
14,500,110 LS
EST TMD QOST OX' C0159 . U(7T.LUM
PER1yY3[TKI9 SUMMARY
PIM CHECK ME
101-000-439.318
C611STRUCTIO14 FEE
101-000-418-000
�3a1.a0
MECHANICAL FEE -- POOL
.101-000-421-000
X24,00~
LJJ114L;TPJCAX 'N'F:fp .. Pool,
101-000-420-000
1~rSs.oOt
PLUMB1140 FI1,F -; POOL.
101-000.419=000
SUB -TOTAL CON. . UC."011` AND PLM C17W K
LESS PLs R -PAID IME3
RECEIPT I DATE
TO _rAL F_XTMTf M8 DUE HOW
14,!W,W
DATE FINALED I INSPECTOR
$3613.30
$0.00
0M
.r 4
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
- BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
FoIrms & Footings
Ducts
tab 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 I
Gas Piping 70
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)
{. k LICENSED CONTRACTOR DECLARATION
F rreby affirm" under penalty of perjury that I am licensed under provisions of
ter 9�(commencing,with Section 7000) of Division 3 of the Business and
Professionals Linde; and=rny License is in full force and effect.
neense # Lic. Class Exp. Date
' 351673 C53
Date Signature of Contractor
OWNER -BUILDER DECLARATION
01!31/2(
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 I Sianature 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 STAT: FUND 229-00-0019334 No. 229.00-0019334
(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: Applicant
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 isnot 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
BUILDING PERMITPERMIT #
., Ate-
DATE VALUATION LOT TRACT
05== $14,%0.00
JOB SITE
APN
ADDRESS 47-,735, VIA MO.N'1AN.tl..
• _ d
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CAWM)AY & COMPANY
HAL 11NMPI'ON dbe VVAC.AnO.9PbOLS
1570BR€?OTMOTIO, VA':IVE, MYr-M, 208
9522 DONALD8014 RL?,
,.AN'rA ANA CA, 9270S
LUC,E:Id.1 E VA.L� EY CA 92336
(909) 1$-604S CS'L77 4335.
USE OF PERMIT
:POOL AND/OR. SPA
I)DOI, &SPA ONLY-.A3.A3t&IMARRIERS SHALT, HE M 11,ACE AT PP:
PWTER INSM-TION. P001.9QUIPNIDIT ENCLOSURE NOT F90t,UDED.IN
THIS PET2Mr.r
Fi>QI,. AN D/OR SP1 W
MdXfE J COS: OF CONbIRUCUON
]1.445M.(3`Ii.
PRR1W I~M SUMMARY
PLAN C11PCK mi ` 101-000.439-318
CONSTRUCTION FE—F 101-000.418-000 $162.00
MECHANICAL FEE -- P60L 101 -000-4,21-000 - $24.00
ELECTRICAL PC%- POOL 101-0.00-420-000
PLS M8JN0 � --P00L 101.000-419-000 aP,>90
SUB -7Y:>7 AL COMMUMON ANDS PLAN OMCK
" R
$363.30
1"S PRY-P.ATT) FELT S
$0.00
'1(ANTU PNRMUF Fj S DUF Now
".31 131A 0
RECEIPT
DATE
BY
DTE F AILED I
INSPECTOR
14
INSPECTION RECORD
- OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
F&'ms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
'�Rqo' 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 01
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 D �- •--/��S
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)
----------
A REINSPECT VACATION POOLS &SPAS
E OF "3
PLANS a 1FTHE ��� 9522 Donaldson Road
CARO ARE OVO, Lucerne Valley, CA 92356
LAI!E THESUS F( NOT _ (760) 248-6045 phone
INSPEOTION'. - LEp (760) 248-2919 fax
.NOO(CE Lic.#C=53-351673
Sales Locations
o Bermuda Dunes, Irvine,
ony„
DATES
California City, Rialto,
FOOL CAPACITY GALS
DOCK
a °
Lucerne Valley
:a a a o .° Q a _=40TORHP
0
a.
(800) 999-18' 1
m a a a:l..:...
�
CITY
GENERAL SPECIFICATIONS
OF LA QUINTA IZE `s � x 3s�
_ _ _
_ D e
a
°° BUILDI
G &SAFETY DEPT REA - PERIMETER
.Q o• a .. . a'.
a
A
EPTH 3' — $ J
PROVED
.. 3' POOL 5 .. •. ..;,. : a: a a
°
TILE CHOICE SQ.
- Q , ° p a
4 FOR
CONSTRUCTION BB.
, ,
;: °� _.;, .. a. :;
a
OPING
ony„
DATES
1� �,
FOOL CAPACITY GALS
HP
:a a a o .° Q a _=40TORHP
0
HP-
----------------------------------- a
cp' •
FILTER FT
-----.^ --- o
..
SPA.a `
_SQ
HE -TER SIZE BTU
.° °•
- d •, : ° 4 °
a ;� I / ::
: a is a a a
- -
-
CHECK VALVE - -
o .'
°'. ------ DECK :4
GASLINE BY FT
POOL LIGHT CLOCK
a.
• O °Od
't j.
c`
°• -
4
•
,4 a. `
ELECTRICAL B`r' FT
-,
AUTO CLEANER--
LEANER-CHEM.
CHEM.FEEDER
PLASTER COLOR
DECK BY SQ .
DECK TYPE
STEP FT.
14T
SPA SPECS.
SIZE '7 ' RAISED !8'�
LITE WATTS too
DUAL LEVEL SEATS a'zo_) d40 N•,
DAM_WALL (I a "
j
DAMWALL TOP
- I E la"WIDE
SPILLWAY S Z X
CONTRACTOR cannot assume responsibility for DATE SPILLWAY ONS
#JETS S
damage to curbs, sidewalks, d: vewoys, cement
slabs, sewers, lowns, trees, fences, retaining walls,
sprinklers, telephone lines or shrubs.
When access is made through a neighbor'
s,�property
it is understood that you, the owner, have that
neighbor's permission and assume full responsibility.
DATE
SIGNATURE
Name: ZA-yV-e-++
Address: L4 ?- 7 3 5 V.' q Ifv0 v'�R. oV�j
City: La Q►A1 Nt'I
VPS0006.dwg TRACT: to ke- LOT#
L, Q