0102-221 (RPL)X LICENSED CONTRACTOR DECLARATION
U) it I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N co Professionals Code, and my License is in full force and effect.
Ou
CV) License # Lic. Class Exp. Date
LO
331412, 0_
cZ I--Da4e7-- ? T'T Signature of Contractor ; y
CID O 0 >�f OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL
U License Law for the following reason:
Z ( ) 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).
C'') () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
O�
a Q WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty of perjury one of the following declarations:
O (`) I have and will maintain certificate of consent to self insure for workers'
X U �= compensation, as provided for by Section 3700 of the Labor Code, for the
OQ —performance of the work for which this permit is issued.
m Q .0 1 have and_will maintain workers' compensation insurance, as required by
O U Q Seefion 3700 of the Labor Code, for the performance of the work for which this
Il L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy NO.
J (This section need not be completed if the permit valuation is for $100.00 or less).
( ) 1 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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply withithose�provisions.
�/Date: �, a Applicant ti,.. i� . e'' )(: :[• f;�v'�,�� �'a
�
Warning: Failure to secure Work 13_S',' 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 Buildi g and S fety
for a permit subject to the conditions and restrictions set`forth on q!IYR
application. a �'�o
1. Each person upon whose behalf this application is made & each�'�et?soh ate
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 dor inspection purposes.
,Signature (Owner/Agent] " l +? //•- � Date - rc
.BUILDING PERMIT PERMIT# y
DATE VALUATION LOT �)f,�No;l�( TRACT
JOB SITE fi
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER I EN (NEER
MW ",AM,
111? CONWRUCI"riolll
1'..A Qi1:tMA CA 92253
Pf 1)U., XRr C'P. 02.60
(lfCj"17 �p343 C",ff�A` 302
USE OF PERMIT
POOL, e1.`ttP.fl.ZRIIALL, BE IN PL.f:CI,AT PRE
PIWAS T RA INSPLT-11c7%3.! XIL RQUIPMNIT M=GURR IS NOT 1N''C1.tI1*D
IN 'F•HU P. IfJ'dX[ U
PWL AANDIOR ORA 1Z000100
:6s',�i11MAT23) CoN R OF WN�S°�'iY'fiO`�`.ri&3N
12.1000193.
PLAN CoHEt':.4; R79 101-000-439,:311 $37,%
C014c:,''f? UCIII01q'm 101-e100-418-0001 8134.00
.1y0 -- POOL 1011-��31�o^y�0-4q r^,I-IF�y/t�0
qu��1��;,00
f�ps',t�Vt�4'�W1CA<�pa.1.�.q�FE
CL'XnS:t•/ 7 Pil.V..vYZ�/� PRE ar 1''(101.r 1. 0.t •'40& 4J�Vi^'000 V 5.00
KA)Ib5 9HO >; 1r -- .PAM a e 101.000.41.9-r 0 $27,00
• r
19 2001
, sB-TcYr.Ai,,�t::CSmyrRurn-i m mro %.Aw a;-. .CK
31 S.7
L ERS PR ,-P .14W ,
,$4).00.
RECEIPT
DATE
,fC
BY
DATE FINALED ' .' a
INSPECTOR
AI
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
Bond Beam
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
_
_
Final I I
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)
- �- — CONTRACTOR cannot assume responsibility for GENERAL SPECIFICATIONS
- - • - damage to curbs, sidewalks, driveways, cement SIZE
slabs sewers lawns, trees, fences, retaining
walls sprinklers telephone lines or shrubs. AREA 4 �0 PERIMETER
When access is made through a neighbor's DEPTH :5 "— 3' +
N _ property it is understood that you, the owner, TILE CHOICE SQ.
(v\ LES V : have that neighbor's permission and assume full RBB. tj
- responsibility. COPING
- — - DATE _ _ s>e POOL CAPACITY ) pip GALS
-- -
PUMP CAPACITY 17,o GPM
14- -%�A W MOTOR HP HP / /L
?LA-)ly 0-4__'4,,, MOTOR HP HP
FILTER 6-3000 SQ FT
I - FILTER RAT /20 GPM
` 4 HEATER/ IZE pp aD0 BTU
TY OF LA QU NTA TURNOVER (p HRS
CI SUCTION LINES 2 ''
BUILDING & SAFETY DEPT. RETURN LINES ' a
�r PRpVED
- •''•'` - + SKIMMER MODEL Arnim ��!
A� CHECK VALVE yz
3' S' tom' 3'
_ FOR CONSTRUCTION GASLINE BY FT.
POOL LIGHT OCK
By
GATE BY
ELECTRICAL BY.
__ ._ ._ ., ,.. •tom. ,o._._,., _
AUTO CLEANER 2_4�7j,
CHEM. FEEDER ^/O -
_ -- - — / - . �• I'npp, - + PLASTER COLOR k,/
Ila
14 DECK BY SQ
_ � iltl-BEC D �Og Ckpo ECKTYPE �ola1
- - ----•- -- -- -...- ---- v-- - - . --- � . _ -_ _. - - ___.-- : --- - � , PLp,NS AN A $CHS TEP
FOR
SIZE 7x 17 "RAISED
INSp ,OEP(10 LITE e 5 WATTS /00
TRI LEVEL SEAT
DAMWALL
- e X FT.
..�5 DESIGNER DAMWALL TOP L '
_ {. _ ?�.` SPILLWAY SIZE �.� X /'WIDE.
._ JJ
DATE SPILLWAY OPEN CLOSED
- + T I#JETS t'p UPPER LOWER
Name: �Q/►L �t���f _.
Address:-795'9.3-
gtL -CA 62 U
--
At
LDERET
j POOLS • SPAS • LANDSCAPE
o s
74360 Velardo Drive Wk. (760) 773-3293
Palm Desert. CA 92260
State Llc.# 331412 Fax (760) 773-3293
17,
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