9910-117 (RPL)fn•••
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LICENSED CONTRACTOR DECLARATION
f hereby affirm under penalty of perjury that I am licensed under provisions of
bhapter 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
574127 ti 01W.3 U2
Signature.of Contractor=
OWNER-BUILDER DECLARATION
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
pertmance of the, work for which this permit is issued.
(30 I have and will maintain workers' compensation insurance, as required by
Sectibn 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.
S AdPFUNI)
(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,
I sliall 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
CodO I shall forthwith comply Vbith .R,provis,,;�.•••--
/ ; � Applicant iea °M 6� •ss �'-
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,appiicaton 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 l 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 ab ve mentioned property for inspection purposes:
S nature (Owner/Agenf)- "` ` Date-�'�,
BUILDING PERMIT PERMIT#
DATE r VALUATION .117,:910.00- LOT TRACT
( f
JOB SITE 415f42. DE R}3IIdG30KC:I94++.".LE APN »
ADDRESS
OWNER ii CONTRACTOR DESIGNER /ENGINEER, (� {
adrirri DNANIE i,l.l' .`ll ��r �' ���i.la3l1!•;i �.ai'"ti j`�v;'Y .ii�. J�Yi I�)iyY
•1542.5 DEEItBROCK (:'IRCI,.E 30! 1 C•t;fUN'.CRi` CLUB Uit.,' .1,i1'1'E F4
LA QUIN` A c A 92"-." 3 PALM DESS i�?' 1-;A 922i'it)
(769)34ti-4,032 CBUO 1044
USE OF PERMIT
K)t1F...:1tvDfOR SPA
P+tit:>d, t+; �,F'F► tial?i:.'a - rht,.rik2it3,'s�'f?�1RJ:ifitti-Sl•iEtiI.i, t'.� lay! e�LE��:l .�T l��.I✓
FPl.AXIER (iy5P)-,V I'ION
POk-9, AlgD;0R, SPA .i.SCti.r'-u} L
',41'���' R�"� l> t'US1 Cos;0j�1,�l� RJJ(:"TI(),'' �i,RN.#)#
t°t,AN CI•!T:{,K t ftil: 101-t7ll()430-3ig °Gi 2,!341
f-��paLcc'tztfc""t•tr_�rw r;�f-a f+3t..��,-.ate-trr)rt xat�.�m
'+1P�., LV41CAL 1'Ps' POOL 1 f f-000) 17t-000
ttLFC!'.ii.KCAL-C,P--ia(AYL ' PA x)00-420-t)Qt) f>i9,tltf
yi-,LlP iBIN i li--FE POOL 127.tw)
;ti?,IfVn_)TAJ., PLAN ('714ECK *41(y?'8S
RECEIPT DATE BY DATEFINALED INSPECTOR
INSRECTlO�J RECO�C�
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BULDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Root Deck
Exhaust Fans
OX. 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 o SSPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBWG 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)
GENERAL SPECIFICATIONS
uan�a�ao-,a'aia, o"uc..nna, �rcryar�, GGfilGfll SIZE 12 X 27
slabs, sewers lawns,trees, fences, retaininn ARS 270 PEIUMETER 76
walls. sprinklers. telephone lines or shrubs. 3X5
When access is made through a neighbor's pEpTH
pmparty it is Understood that you, the owner, TILE CHOICE GROUP 3
have that neighbor's permission and assume full I g913.33'®+6"
responsibility. COPING CANTILEVER
DATE ��,,.,�*PC)C)I CAPACITY 7500 GA[
MOTOR HP STA RITE Hp 1.5
MOTOR HP — — — — —HP -
FILTER STA RITE 300 SQ FT
FILTER RATE 102 GPM
HEATER LAARS SIZE 250 BTU
RIRNOVER 2 H
SLIC110N LINES 2 "
RETURN LINES 2 "
&- -A%Arn u^mr-i A kAUDihA IM tr
FT. 70
AIRPIPE
T ' muIv%.Lr-ml rf%--------
5',0" r- R3'-6" — — — — — —
f' I3'-3
R6'-3" `\
P/L
5 T-3"
1616"
9'-9"
3
R3'-6"
I1�
11'-" 4'-6"
SLIDER
1-3:1 NJ 110,14
RESIDENCE
— R7'-6' \
1"
.9 r- LIGHT SWITCH
SLIDER
7
P/L
BACKHOE ACCESS
NO WALLS Ef
r
6.0'
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.11
APPROVED N
FOR CONSTRUCTION
DESIGNER
DECK TYPE SLT FLASH NTRL GREY
STEP FT.
SPA SPECS.
SIZE 7 RAISED YES+6"
RANDY/EV
LITE 100 WATTS
RI LEVEL SEATS 22" 24" 27"
DATE
DAMWALL 6 " X 7 FT.
g-20-99
DAMWALL TOP ILE "
SPILLWAY SIZE 3 " X 12" WIDE
ifJr-
Name* CENTURY HOMES/ DONELLY
AddreSB: 45-425 DEARBROOK CIRC
cb-` LA QUINTA PHASE 2
TRA - IENNA.DELREY LOT# 22
poo/5
DATE 1 PALM DESERT
By
73-011 COUNTRY
1/8"=1' SCALE CLUB DR. STE F-4
PALM, DESERT CA.
NOTE. 'LANDSCAPE AND FURNITURE 922:60
ARE SHOWN FOR ILLUSTRATION , (760)-346-4032
.ONLY AND ARE NOT INCLUDED, I A
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