0202-243 (RPL)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
f
f .1 fi7;1/% C�,5�3 . 7 f3 I IV
Date !� )Signature of Cor�t[acto�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.
( ) 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:
Cartier Policy No.
STATE ITUND. 226.01.091034
(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 a to -b ce ome subject to the
workers' compensation laws of Califprnia, an'd ago that if I should become
o . ,.R(
subject to the workers' compensation ,ptio{ulseions of'Section 3700 of the Labor
Code, I/sha lArt6th comply with,those provlslor�S.
Date: �� U / Applicar�t� i`� 1 `
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 repreSerita{fives of this City to enter upon
the above-mentioned property for°instio -p�poses.
Signature (Owner/Agent) ! Datel,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT p2(A2•,7A3 TRACT
�y♦ �r �t t
-/.Gw7IVds 1➢A.��4.�
JOB SITE
APN
ADDRESS
78-3 DULCE DKL ala
-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
(1,AI31`a AY &. MI MP NY
ITAL kLAI+ MN 68 POOL.q
17480.'F-.. ) 7M ST. 0106
9522 DONAI.D80A PD,
TURF.51 CA 92780
LVaIMM VALIRY C4 923S6
USE OF•y�PERMIT
** }}+q
P001 n AND/0111•��ryry W5-a�'x
POfIL%M..AL.g":AR.IUMSiALL S901;dACtAi7R:- .ASTER
SdiTiUT101P001r EQUIPMENT F.W. .1,0SURE NOT INCpAMIE ,
I'b011liNDIORSPA Y OVD.00 LS
EIFr1.MT.E:D COST T OF C:tOMURV,1C.MON
PLAN CHECK PRE 141-0t 0.439,-318 $1�5.3t1
CONSTRUCTION REZ, 1011 -000-4 18-00 $163.00
MWECHANICA.i,kl 1;'r --POOL IQ1rf 00 -42,1 -OW $24,00
ELECTIUMAL FU -- P00;, 161-000-420-000
PLUMB110 M -- POOL 101-000419'0bi1
FEB 2 5 2002
WYOFLAQUIM.'.'A
3t,�,-'.'MTA ® :trc ifa�a 10 , :
:363.3 o
75 IWIE NOW
46 -
RECEIPT
DACE 4:7BY
DATE FINA ED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
_ 2 -
Footings
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
— Z
Underground Plbg. Test
Final
Gas Piping
_
PLUMBING APPROVALS
Gas Test
Electric Final
�2
. 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
_
?/ o t -
Gas Piping
Gas Test
Appliances
Final
C--
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lxwv Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
S'
-•A,; 1
CITY OF LA QUINTA
WILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DAM a a OZ BY�
QNIift VACATION P001,S &-- SP1l,,,S
9522 Donaldson Road
Lucerne Valley, CA 92356
(760) 248-6045
(760) 248-2919 FAX
Lic. #C-53-351073
Sales Locations
Bermuda Dunes, Irvine,
California City, Rialto,
Lucerne Valley
1 800 999-1811
GTERAL EN
SP CIFICAiI®n
SIZE �`i' X 0-27'
AREA PERIMETER
DEPTH — S
TILE CHOICE SQ.
RBB.
e
• _ _ •-�1�,`� - ` / l �}-� ('%N / COPING
POOL CAPACITY GALS
PUMP CAPACITY GPM
MOTOR HP HP
' MOTOR HP HP
" FILTER SQ FT
FILTER RATE GPM
_ - HEATER SIZE BTU
TURNOVER HRS
• SUCTION LINES
RETURN LINES
SKIMMER MODEL
CHECK VALVE
Cx GASLINE BY FT.
����- i, POOL LIGHT CLOCK
I ELECTRICAL BY FT. -
+ AUTO CLEANER
CHEM. FEEDER
PLASTER COLOR
\ DECK BY SQ.
DECK TYPE
STEP FT.
SPA SPECS.
/i SIZE RAISED
SL— LITE WATTS
DUAL LEVEL SEATS
I DAMWALL
DAMWALL TOP
SPILLWAY SIZE X WIDE
CONTRACTOR cannot assume responsibility for DATE SPILLWAY
damage to cubs, sidewalks, driveways, cement #JETS
slabs, sewers, lawns, trees, fences, retaining walls,
sprinklers, telephone lines or shrubs. Name:
When access is made through a neighbor's property
it is understood that you, the owner, have that Address:
neighbor's permission and assume full responsibility.
City
DATE
SIGNATURE TRACT LOT#