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LICENSED CONTRACTOR DECLARATION
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
618892 C53 05/31/2011--- .
/ate 7Signature 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 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
performance of the work for which this permit is issued.
( %h 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. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
'LARUNDO, N WS. t i ;Rililtlti`��� 1
(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=those provisions. _
S Date: !PL I Applicants
Warning: Failure to secure Workeys� ornpensation coveragems unlawful and
shall subject an employer to criminal penalties and civil fine -s 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
th"bove-mentioned property for inspection purposes.
USignature (Owner/Agent)-g • .E���-�-+ Date 7
BUILDING PERMIT PERMI
")7-169
DATEt'ATION �ivmltt.tl�i LOT TRACT
-7
JOB SITE/ f i
APN
ADDRESS 7! -310 DESERT STREAM
-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ANDREW S & ANDREANA HOCIIRIAN
RLUr .11AW N 1'C 01,,S
19310 DESI3RT 91T EAM UR
2318 & VINEYARD AVENUE., SUITE A.
LA (iJ KI'A CA 42253
ONTARIO CA. 91761
e,)00,)947-6474 CEIA 5240
USE OF PERMIT
PWL ANDiok,84PA
,
'' as
POOL k- SPA - ALARMS / RARRi[ =RS SHALL 13ir iN .PLACE A i
POOL ANL!IOR SPA 699,000.00 LS
U,NXIAIA'I't:'/J COST 'OF C.ONSTruitTION
191000.00
1?FAMIT EEI< SUMMARY
PLAN CREEK FEE, 1()1-000-439.318 $128.70
r'(wg1.R1 rrwrit'iN 1() I.W-41lt-f)(!(f �2aft �n
_NXC FMNU A1.1'EE -. fWll 101.000.11:1-!it)C!
111 LCT I;UCAL Ff.L -- POOL 801-000-420-000
P1. UMi3fNO FEF •- VOU). 101-000419-000
P
c[.nl.'lx,yryti, rrriSTRf_x,'c7N R1wfD >�irA.N f.1i►.;CK
S4Z2.70
LESS 11.RT%11,,1J 7 PEI'IS
1%O.04)
r '!'CVFA%1, PERM IT :iF EEN 014, NOW
$422.711
a.•W a
RECEIPT
DATE
BY
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
Fireplace T.O.
Fans 8 Controls '
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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 Finai
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
. Pool Cover
Sewer Connection
Encapsulation
417-3--
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
7. F
2
-
11,
LID 7'01,4. sQa t� � I tj
A)jD HAND RAIL- L l�
SKIM+'X
il
�I \
13'
hJ(t,RE Pt -t'
13Y OLA)t.IE2
i
J �
3 g -EPS
50 C", 34'
NOC�MAi.I
1 q 31 O DESEI?f 'sTRr--Arn DR .
SEE ATfACi-IED 51-I ECT -
FOR ELECT. Ho O K U P -:-
GdAG
3. GENERAL POOL SPECIE
Pool Builders
51ho.91954
(8090) 476-'5.560 MAXIMUM WIDTH: 4'
BWMAXIMUM` Fax (909) 947-4393 i LENGTH:
POOL DEPTHS:
IEXCAVAT11front
Access Rear
Bob Cat uttle Dig
Remove Dirt
POW2318
S. Vineyard Ave., Ste. A Remove Stump(s)
Lic. No. 618892.053 Ontario, California 91761 Remove Fence
Replace Fence
T140l'`'1AS CJI DE � Remove Concrete S.F.
M? S4q _ 51 . Sawcut Concrete Ft.
C15 DESERT EAGLE C -r STEEL
Expansive Soil Steel Pattern BH
w PLUMBING ,
1 U Filter Run Ftg: ( 5
w Return Lines
P -Trap B/Wash Line .
Gas Line_W:�!_Ftg -7A'
CITY O F LA Q� j I N TA Drill Drive
BUILDING & SAFETY DEPT. ELECTRICAL
RICU4 Ftg
APPROVE® F GUNITE
FOR CONSTRUCTION Love Seat
Q Swim Out
Ext. 2nd Step
DATE 7 l By R.B.B. 4," in. X ` Ft.
R.B.B. Iz' in. X 110' Ft.
COPING
Type CAK1i LaA'Er7
J •
n TILE
Type
Spa Dam
lit Accent Tile
J
b
�9
A
Q
A
' �p0L i
1i
DECKING '
Type C-C'hjCf21a-1*/
Color I
Risers
Footings I
Mastic I
Drains
EOUIPMENT I
FilterType SizeI
Pump HP Z YL
1 S
B.H.C.C.
Yes
o I
P/P+/Or Ozone
Yes
o
SmartLi ht
Yes
I
500 W Light
eg7
No
SmartVac IIefts
No
Heater BTU
007
Pro
Div. Board
Slide
I
Water Feature:
PLASTER
Color L-g44iTL-
SPA
Size 7 -D1 d
Plumbing Run
Dam Wall Length
Number of Jets
Blower Hp
Remote Model k
Spa Side Switch
SmartLight
100 Watt Light
In
Yes
Yes
Yes
Yes
Out
No
No
No
No
BUYER
Initials
• Approve above specifications
• Approve equipment location
• Understand that decking shown is for illustration purposes only and
understand that they are to receive,46 square feet of deck.
Signature Date
Prepared Especially For:
ANDREW 14KY-NfIA
Street -11310 TXF56RiS1f966vl G2
city LA QUl).TI'A CLl zip '12-7-!53
Home Phone Work Phone
Designer Job No.
Lot Block Tract
Mapsco No.
1