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0205-094 (RPL)N lJJ O d `M W oZr� CID O O k- t0 r` LLI LLI a. U) Z 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 # Lic. Class Exp. Date- r -77 i 6'0 115113 Mir DateSignature of Contract 47 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). ( ) 1 am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION 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 Stiction 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 U.TA,1'r, };`IJNp Policy No. 229-?2OW (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 Vshould become subject to the workers' compensation provjsions°of Section' 3700 of the Labor 0 e, I shdll forthwith comply with thos,�,pr`b�lsionS:"_;4-- __ _ ,: 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 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 representatives1,6f this City;to enter upon the above-mentioned property for jr s'5ei ion purposes.,, ! Signature Owner/A egt f— "' p - Date 9 ( 9, )tf .i f BUILDING PERMIT "t"M"" 20 DATE VALUATION LOTTRACT QI f1Dli!' li YC�,�' r,fto JOB SITE APN ADDRESS 4_%-450 OWNER I CONTRACTOR / DESIGNER / ENGINEER 841171 r KI` & NATAUE ATvL'tEW00 Imo+ Cj71TbUA CA 9225-1 USE OF PERMIT POOL.WL`+ OR SPA. try.,AT., 3,T', Vtj1)A TTlII_;:X, Tt4C. .70-1180 t'fUtlT�irR V 0A.0 43 aANC"CiCt P�I'i rwl; CA 9277i9 P00USPA,AI.f R14SM.Wli RSSr1ALL BE IIN PLACE tt1001! TO PIS'&PLA;5`i`IN. N311i,KCTION, 12 L.F. V FIIOH B[MK WAI.:i. f1001,, All IWOR SPA S 1{ I'. WA11L 16100,itr3 Ir€# 12.00 L? PE I' WE 611MVIA)13:Y PLAN CHJr!,CK FE -11, '101-000-439-318 V117,00 CONSTRUCTION n.T,,• 101-000-4 t "00 W0.00 MRC`•1&'l.NICA],Ib E -•POOL 101.000.4121_0(K) $24.00 EL&CTRICA1, IEEE - POOL 101.000-x!20-000 € .0i1 PLtMBINO - POOL 141-i".4119.000 $2100 [VIA{ U d ?f'1142 CITYOFLAAUIRiTA AN13 PLAN CHECK 'I'OTMI :1taMMff 1r1F_XWE NOW RECEIPT DPT, `` BY-�� DAIIE_ FINIA'EOD� I INSPECTOR :5 'r o vl_ 01100 11 INSFECTi��� RECOkD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BULDING APPROVALS MECHANCALL 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 BLOCKWALL APPROVALS Steel POOLS -SPAS 1, � ✓ Set Backs Electric Bond ✓� Footings _ _ Main Drain Bond Beam Approval to Cover �. Equipment Location Underground Electric Underground PI . Test Final Gas Piping PLUMSNG 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 —/?_©z, Gas Piping Gas Test Appliances 44 Final Final Utility Notice (Gas) PILECT=AL 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: /2 CF - CS CITY OF to QUINTA BUILDING & SAFETY DEPT. APPFIOED FOR CONSTRUCTION 20 CAL -NEVADA POOLS MARK TOW 70180 THUNDER ROAD RANCHO MIRAOE, CA. 92270 PH 8310860 LIC. N 777601 VICINITY MAP A. r , 1' V CA Designed by KERRY R. KOEHNLEIN PHONE 360-0012 OWNER to fence pool area and install self dosing and=rWx ing gates per code. NOTE No dirt will be removed, returned or graded after day of excavation. NOTE: Relocation of equipment pad will result in additional cast to owner. NOTE: FII pool immediately°after piaster (follow instructions). Do not use rubber hose. NOTE: Do not turn on pool light when pod is empty. NOTE: Wet down concrete shell at leasttwice daily for seven days after slid is installed. I have reviewed this plan and hereby approve total plan & specifications. 5.3.6 1 DATE j POOL SME _.I_Z< _ X 30 oe0 __1_ x_i_ x.5 Surto Ara_ 14 6 pvinieter EXCAMOOt AMM Grading � IL Dig From . k W %v.060 _ Obsbdes Walls Removedpe-— Misc. PLUMBING Filter A&& Gs o:,1 size 3 vo Pump TAC Size_2.1r Booster pump 'Q . Sldrn Ran—1--0 - Main Drain_ Ret Fiu Line iMr z v Puriitier A `7' P t c.o T Autogearner Poh.a♦,�cS Htr Type 5't n Size yfv C Gas LJF FOUNTAINS—SPRAY HOS—WATER EFFECTS Type _arli�=_'d CIVO-S Size Numbing Lemli 3 ® valm i Booster V4 Type_____.;._Size misc._ STEEL GUNTTE Eng Sur -charge 6'1188 12'_,!*&_ 18' 2e Step Risers Spa Wag Width_ Benches I S~ Love Seats ✓ Spa Dam Wa11t 2_Notch •"l MLSc. ELECTRIC Total Run UF._3�FiberOptic 1_1L Renft R 5� Sna q j-J71v"' Mise _ TILE WAAW 4 * S Coping step & Bench Tits/ %. C S MiSC.� mrft. DECKING Sq R f 9'r' Type �l.T_ Color-LBD Nal Concmte Sq Ft Cantilever D.O.D. LJF Step Risers Mist: SPA sixes Area 9 Perms Pump Bower__ Spitlwayl jobMist. - - wit � F�� I Lightlmv. rr INTERIOR Fi H 3 Color o 'SP «c.. r-. r2 . CITY _SOLD On PHONE (H) DRAWN BY DA r