0207-002 (RPL)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.
License
+# LLic. Class
/�1 ^ Exp. Date P� 2�
'Date ; Signature of Contractor
:
N1.`,
OWNER -BUILDER DECLARATION. '4
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:
Carver STATE nftJr� Policy No. 229-01,04103714
(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 mannerso asto become subject to the
workers' compensation laws of California and 'agree\ifat.Yol should become
subject to tie workers'-compensation°,provlsions oNectio 3700 of the Labor
Code, Ishall° orthnithi comply witfrthose'p�rovii' 011s7'
Date: k MAVApplicant "' a
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 conditigns 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 a4state thattheabove information is
71
correct. I agree to comply with all City and`State.°laws relating to the building
construction, and hereby authaori. representatives of this City to enter upon
the above-mentioned property f i igspec on_ purposes.
Signature (Owne
14
BUILDING PERMIT PERMIT# ;
DATE " VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 70-322 CALU. . LAS REAMBLAS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MARY.1,010: 't3ILiMA'AN
N.f L 1hf%ff '0N Ciba 'tii;JiQAT(ON POOLS
78-&322 t. UXLAD 1.s�+iBIdW
9522 DOIT,�.�'t.")ZON :
0601248 -SUIS OBL6 4335
t
USE OF PERMIT
POOL :A.)W/UR QP..
POLt,OS3`IA.. AT .ARMSfH ARAIERS•,S,HAJ L RE 94 ',PLACE A3' PR&Pi..,EL;iTER '
i:t3ORCTIOX.UtPMI.''� T 1';HCf.Cti;3C£.RF NOT iiYK1,1JLi D
V.A..+ A T !CTI 00 :i's
E1UTMTKD COOT OF COXISTRU(MON
PKRWf YZE iii` car. ARY
PLAN CHEM 11% 101 *0004439.318 SliWO
C014S°f RUC; 5'1014 FEE 101-000-418-004 $162.00
M� ECJ'H..��Ayi�itCtAII,,-- FOOL0,
q1.{�Jj`Ql-f(��(/3yt�?-421.9.,000 p$,''2A
C: atI�YAJ�'.t[.i9uA), 1 lr,.Fw - P001,• 101-000-4JC 0400
P'Lii➢v111It40 FEX «* 11000 101.000.419-000 = S27.00
11 II.
03 1001
CI`fYOFLAQIjINTA
y��y�- a� +�Ap�TT ry�i�lr�5�+r'vt�FtI+NANCEDEPT,
i�A7 UFFS-A.t�:;er L 6.c�.✓m F.B'h4d6.ra {.i a 4}.it
ah a
$3614.3 a0
FEW
$0,150
TOTAIL 1°x`248 M NOW
ECEIPT
DATEy
B_Y
DATE FINALED
INSPECVQR
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.
Griffis
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
o�
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
- v�
Equipment Location
Underground Electric
-- o
Underground Plbg. Test
o v
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Rumbing 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:
rr ,Iv � C�f- ce --�
Citi( OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DA %/o Z BY
MAGA 1AVIN rwVL 7 a Jrn�
9522 ibaai&cn Read
Lucerne valley, CA 92136
(760)2186045
FAX: 1760) 2-08.2939
Lia sC3}351677
Salea(.o®aum: ��
_ 3)mnum Qac [Tina
cdImmin CST•. Rielq.
Lecoae VaSky
I (no) 999.1811
LOT -30
SCALE: V&"=1'4)•' I DATE: JETS
CONTRACTOR cunuotassumereponssbilityfotdmoegemMLft . Marvlue Knzman
sidmall s. driveways, cement, slabs, sem n. lawns, 48as, fences,
cebining ,.•aus. spnnkleas. telephone (rims mtd shmba. Am,rF,,. Calle Las Ramblas
when access is made Oirmrgh a neighboes psoperty it a underxnod that you
Ore oisnea. haee drat ne,gbbo spamissinn andassome cegaonsibty. �tllnla
/ 1 CtfY: Cc
DATE " r`' PRASE: - TRAc7. 295&6 tare 29
."7 a - 3 z Z-
1..
DR
SPA. 1
.07
LOT -30
'1E
VACATION POOLS & SFAS
9522 Donaldson Road
Lucerne Valley, CA 92356
(760) 24x-6045
FAX: (760) 248-2919
Lin. #G53-351673
Sales Locations:
- - Bermuda Dunes, Irvine
California City, Rialto,
Lucerne Valley
1 (800) 999-1811
SIZE X
AREA PERIMETER
DEPTH
TILE CHOICE SQ.
RBB.
COPING
POOL CAPACITY
GALS
PUMP CAPACITY
GPM
MOTOR HP
HP
MOTOR HP
HP
FILTER
SQ. FT.
FILTER RATE
GPM
HEATER SIZE
BTU
TURNOVER
HRS
SUCTION LINES
RETURN LINES
SKIMMER MODEL
CHECK VALVE
GASLINE BY.
POOL LIGHT
CLOCK
ELECTRICAL BY
FT.
AUTO CLEANER
CHEM. FEEDER
PIASTER COLOR
DECK BY SQ.
DECK TYPE
STEP FT.
SPA SPECS.
SIZE RAISED
LITE WATTS
DUAL LEVEL SEATS
DAMWALL
DAMWALL TOP
SPILLWAY SIZE X WIDE
SPI LLWAY
,CALF-: 1/8"=V-0" DATE: #JETS
CONTRACTOR can not assume reponsibility for damage to cuffs, Marylue Krizman
sidewalks, driveways, cement, slabs, sewers, lawns, trees, fences, NAME:
retaining walls, sprinklers, telephone lines =4 shrubs. Calle Las RamblaS
When access is made through a neighbor's property it is understood that you, ADDRESS,
Calle
owner, have that neighbo 's permission and assumefiAl responsibility. CITY:La Quinta
BATE y f t lr. P1ASE: _ TRACT:_ IAT# 29