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LICENSED CONTRACTOR DECLARATION
I K*eby 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 # Lic. Class Exp, Date
3 i 4127 A 8/31/99
= r -- -•"''•rte'- ) .r..
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, Land the structure is not intended or offered for
sale (Sec.. 7044, Business & Professionals Code).
( ) . 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section , B&RC. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the -following declarations:
O 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
ion 3700 of the Labor Code, for the performance of the work for which this
permit is 'issued. My workers' compensation insurance carver & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
O I certify that in the performance of the work for which this permit is issued,
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•forthw th comply with thos provisions: - r
jlate: r Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000i 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, indemnity
&.hold harmless the City of La Ouinta, 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 ove-mentioned property for inspection purposes.
17gnature (Owner/Agent)- =�" °' ' " Date '
PERMIT #
BUILDING PERMIT
��Ja►.i`.liall`l
DATEVALUATION 18,400 00 LOT TRACT
_JOB
SITE
ADDRESS 4.3 2.20 ➢)D,91HE 41.1tIVE
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CE:11%r1TJRY CRO -WE'LL t 01164WIr.JAJMES
�:1TXF UX)SON C:0N.%'f'RUCT 1(XN
1535 SO. "13" Sf'RE I',, M, #i 7.00
')3-01I COON1 1T%. V C M)B C1R., SUrrE F -f
SAN BERLNAAFCI:ANO C.A. 92408
MAI D.E`+I R1, CA 92:?60
1700*j3zka5-40 2 C 111;tt 1044
USE OF PERMIT
POOL A v i0k SPA
Kti)US11A, ALAi2R:WWbAi"i __1ZS .Si'4ALJ. DE iN Al Fit, .-1 A.STiA
[N8%J4('f'1QK l" ANUN (; -EIALK BELOW
POOL AXD,'GR I>3,40001 LS
i"Eall;Nii T FEE SI.ft44AW-1
PLAN C 14ECK FFE 101-000.439-:318 3121(Jo
C.ON"L.-TRIiC110N FEE 100-000-419-000 S1y`i,)1)
NIEC:T1ANICVU. FCC,, .._'IVOOL 10-UI>f} 9:l-(1(Jli :'�.!;r►
tI EIC.`'ntfCAL, FRET -- PCX-)J. i0i-131010,420.000 1�lSAU
NLUi4ft11NG FPI' .,. P0(;>f.. 1()i -OM -419-000 $27.00
:;i.Ff3 TC7ri',A1., CONS 1'f?U,,.-q(.lN' AND K. -AN U. -IFC:
DESS Pf111:-.P,1UD VESS
7'Ifff'AL VERMIT II<Ii R -S DUE NOW
��OB2.7li
RECEIPT
DATE
BY !
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DINE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Compressor
Framing
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 a SPAS
BLOCKWALL APPROVALS
Steel 4,44440
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 Enck)sure
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 Pourer
Final - _�A
Utility Notice (Perm)
RAISED BOND BEAM CROSS-SECTION.
OUTSIDE EDGE FINISH
WATERPROOF BOND BEAM
/-DECKING
271-9"
I�
A
GUNITE
ANTIQUE GOLD BOULDERS
NOT TO EXCEED 24
R7'=3"
door
c�.,�.� .:•. i,��Ti;�•:�/, ;gin
12"
1 14'-3"
7' 1
16-3
RESIDENCE
LEAVE DIRT IF NECESSARY
5'
°7c
- ♦15"es
♦IS"TOP OP DAM
WALL
WATMUXNE
AIRPIPE
SPA @ +18"
GENERAL SPECIFICATIONS
IZE 12'6" X 26'
tEA 280 PERIMETER. 73
10
TILE CHOICE GROUP 3 SQ,75
g 2N@+12"101(9+18"
COPING CANTILEVER
POOL CAPACITY 9,000 GALS
PUMP CAPACITY 103 GPM
MOTOR HP SIA RITE Hpl.5
M611el!'HP=mmmmmm"
FILTER STA WE 300 SQ FT
FILTER RATE 102 GPM
HEATER LAARS SIZE 250 BTU
TURNOVER 2 HRS
2 of
RETURN LINES 2 if
SKIMMER MODEL 2
CHECK VALVE YES
GASLINE BY SDC FT. 120
POOL,LIGHT 400 W CLOCKT104R
ELECTRICAL BY. SDC FT. 200
4UTO CLEANER ...................
-uru CCCnrD .....................
=
6!-61# t.- DECK TYPESLT FLASH NTRL.GRY
SPA SPECS.
DESIGNER SIZE 7 RAISED YES+18'
6'-9" LITE 100 WATTS
18 16'=9RANDY/EV RI LEVEL SEATS 22 24 2711
29'-3" IISTACCOTONTCH HOUSE ,�
DATE DAMWALL STACKED
- & kF
R6 3 �G TY DEPARTMENT - DAMWALL TOP QUARTZITE "
2-23-99 SPNPLWAM Often o •bXe am
\ CONDI ALACKED QUARTZITE PILLLWAY
REVISED XXOPEN CI OSE
CCEPTED F01 I CONSTRUCTION # JETS 4 UPEROWE
- ECT TO INE ALLATION AS PER
6'-6"CENTURY HOMES/COMES
2 ( Addtess:45-220 DEBBIE DR
LIGHT s ITCH I ALL APP tCABLE CODES �U 'RACTMARFi i .A i.OT# 43
Bodsoll
Opficc, cef poo/s
PALM DESERT TEMECULA
N 73-011 COUNTRY 28910 RANCHO
1/8"=1' SCALE CLUB DR, STE F-4 CALIFORNIA RD.
PALM DESERT CA, STE TEMECULA CA.
NOTE: LANDSCAPE AND FURNITURE 92260 92590
ARE SHOWN FOR ILLUSTRATION (760?.346-44320976-SWIM
ONLY AND ARE NOT INCLUDED. i it W A_s7AT77