9610-020 (RPL)U)
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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
r412 7 &5111
Dater—�� Signature of Contractor
r
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'.Iicensed
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 r
I hereby affirm under penalty of perjury one of" the following declaration's:
() 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.
k( ) 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 MjrW&kers' compensation insurance carrier(&',p6licy no. are:
Carrier Policy No.
(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 I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with hpse provisions.
/Date: f • "t a Applicant
Warning: Failure to secure Workers' Com pensati n 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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
/Signature (Owner/Agent)/ " r' , n 4 ,.DateA 7
1 t PERMIT# CONTROL#
`! t BUILDING PERMIT 9610-024) 4184
DATE 1(}1 )6 VALUATION �.4r (i(2;012 LOT TRACT
JOB SITE79-295 llQ�;�fi.1~ WU (:R S'C .> k. APN K pt
ADDRESS
OWNER�.v ,F( 'i,
CONTRACTOR /tDESIGNER ENGINEER
f
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RAN £cE.Et:R OINO CA
CA'['REDRA?. CITY!
CA- +122-14
C AL4 1044
USE OF PERMITPO.')
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POOL ANI) +.PAON1.Y
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E'S4114t/=a"0'.E3)
[,O '17 OF Ct",'•NS'!'RilC".>G 1:tsN
14,500.010
PT, AN . MRI -is,
$105.30
10 E -%9-41 R-."
141,x('f°RXA L,F,81 -' — KNX;
1()E. -000-4204)0Q
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82.1 ,1E fTAL CONSTRUCTION ANL) PLAN C'HECF'
® 2;tMS .E''134'AIE fa3 i. S
OCT 1996
RECEIPT DATEBY ( DATE FINALED INSPECTOR
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
Fire lace 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
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping 11416
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,l4; ice (Perm)
-I'
START POOL
P
SPA SPECS.
GENERAL SP.ECIFICATIO. S
SIZE —71
RAISED N/A
LITE 100 WATTS
TRI LEVEL SEATS
22" 24" 27"
DAMWALL WIDTH 6"
SPILLWAY SIZE V x 3"1
OPEN X CLOSED
JETS.#___4 _
SIZE 14 X28 AREA 309
DEPTH 3' 6"X5'X3' 6"
SHAPE FREE PERIMETER 7 5
TILE SIZE KMA 350
TILE COLOR KMA. 3 5 0
RAISE BEAM A
COPING CANTILEVER
POOL CAPACITY 2, 00 ' GALS
PUMP CAPACITY 95 GPM
MOTOR HP MAXI II HP
R LINE
MOD -MEDIA 150
FILTER MOD -MEDIA 150 SQ FT
FILTER RATE 105 GPM
TURNOVER 2,5 HRS
RETURN LINES. 2 "
MAIN DRAIN I "
SKIMMER MODEL U-3
CHECK VALVE N/A
HEATER LAARS SIZE 250,00&
GASLINE BY SDC
POOL LIGHT 400 WATT
SPA LIGHT 100 WATT
CLOCK MANUAL
ELECTRIC' BY SDC
ELECTRICAL BONDING BY: SDC
TILE AND COPING SDC
DECKING BY SDC. 798SO. FT.
CONTRACTOR cannot assume
responsibility for damage to
curbs, sidewalks, driveways,
cement slabs, sewers,
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
or shrubs. When access is made
through a neighbor's property it is
understood that you, the owner,
have that neighbor's permission
and assume full responsibility.
Name: �,7-
Ga�� ,LISA
Address: DESERT CREST DRIVE
Q[tW LA QUINTA
w aump4g" � Tract: TOPAZ LOT: 22
SHOW ROOM
73011 COUNTRY CLUB DR.#F-4,
NSTER
PALM DESERT, CA. 92260 U� XEgCE
COPS PHONE (619) 346-4032�p�M(�cnj LIC # A-574127 �Ec�JMIS