0307-006 (RPL)LICENSED CONTRACTOR DECLARATION _ r
F 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
7 916 JC:i7 Fst::+ 5,! 3110.
Date ''%f'' ` Signature of Contractor {%`/«''
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that b 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 confracting with licensed 1
contractors to construct the project (Sec. 7044, Business & .Professionals
Code). s
() I am exempt under Section B&P.C. for -this reason
Date Signature of Owner V,
_
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 & polic • no. are:
Carrier 13TAT�: Ftd 4 Policy No. 1629CV-2M,
(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. shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if b should become
subject to the workers' compensation provisions of SectionJ, 700 of the Labor
Code .1 shall forthwith comply with those provisions.
,Pate: 7, Applicant-
/
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.: r,
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,'indernnify
& 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 laws1relating to the building
construction,. and hereby authorize representatives ofr this City to -enter upon
the above-mentioned property for inspection purposes
Signature (Owner/Agent) 1' / a al Date \
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'BUI_LDING
PERMIT.'PERMS �joJ
DATE 1 ;;VALUATION w ii3(i� LOT TRACT
JOB SITE
ADDRESS ��4tie:A�RLri%r��:
APN ..
OWNER
CONTRACTOR/ DE,S/IyGN�E�R/pEN
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USE OF PERMIT
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. • ,' :JUL •'2 5` 2003 . - ,' ,' .-..
- • . -
CITY OF LA'G189IN
FWANCt DEPT: r
RECEIPT
DATE �n
BYA
D
INSP OR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
0. K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
nrwtall _ Int 1 nth
Final
BLOCKWALL APPROVALS
Set Backs
Footings IN
Bond Beam Yll?
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
Annlianrpc
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
OPERATION DATE INSPECTOR
- MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Final
POOLS - SPAS
Electric Bond Y -
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Piaster
Pool Cover.
:Encapsulation
Final
COMMENTS:
80-880 WEISKOPF DR. (Lot 40)
La Quinta CA 92253 N14,sTER& PGA"
GENEILU SPECIFICATIONS
Dn"EMIONS' POOL SPA
Leaown: 42'0' Tiff'
Wldth: 14'O" 7101
Stu a area_ Up w 600 SP 499F
Perimeter t23 FT 28 FT
DqA& 4'X5'x4• 42" MAX
Acme
COG= .IIA
Sod i GrouI: :UA
EXtM S4¢ m EgaiPmeat: 30 LP
Rake! Sp B)Vm wkk vah m YES
Oedicatod Vac Lmr YES
On l.ma Extra: 30 LF
(hs line far BBQIFire Pit 20 LF
Spa Jets: FIVE BACK JETS
Deddur,
Color vw3dtIimsb: 1725 SF DECKIXG, CAP @ RAISED SPA
Caotiiesw F or 1sl LF I TV005Ji BAND TPIM
r Deck Drams (W LF): , 0' baw to sheedside)wd
&.P R— (6)- LF), (4) 2x2 PU-kSTERS
Dem Wan: +18•
Raised Band Beam: 21 LF IFr, QVA.RTRZ(i 1'H Vt>0ER
Umbrella steev c YTS •@ BDQ
BamcYTJe Grow 151 LF 6` GROUP 1 OR 2 TH.E
Qumtzft 6- W9crtI c NFA
Step TA= 32 LF ON ENTRY STEPS
Tile RaLAod Areas: 18 LF @ RBB , 6 FT STACKED SPILLWAY
—masonry.
Spillway. 6 PT QUARTZITE STAJRSTEP SPH.LWAY
Walutad: (1) 12' CUSTOM CASCADES(CEKTEREDI
EBQ: YES (SEE ATTACHED DETAIL)
Fsrco: NIA
boulamMA
Access Wali: 'REMOVE AND REPLACE
Egliipmmt Wal YES (2- WD(G WALLS)
Pabal/.SmD0D"[%1er STUCCO EXT. RBB. BACKSIDE(ROUCTU)
Pool Plaiab:
W1lltc Pool Plmier. NIA
Pebble Pod: PEEBLF COAT
yArkmeot
Pomp: HAYWARD NORTHSTAR 2 HP CIRCISPA
Pump: HAYWARDh'ORMISTARIHPWATERFFEATURE
Filter. HAYWARD40DSPCARTRIDGE-TYPE
Heade:HAYWARD400kBTU 1.06NOX
Caotraer. PS 2100HAYWARD REMOTE TNT. MOUNT
Ha)waidNasigeear. YES
Pool LiOL T*'O.2CO-WATT
Spa Li gid: ONB - 200-WATF
Raillcmim System YES- AQL?a-RITE SALT SYSTEM
Wet" Feaiore (1) CUSTOM CASCADE ON RBB PER PLAN
T.an(scue: SEE SEPARATE DETAIL
Palin Corer-. NIA
Pim NA
MISC. SPFiCIFTCA LTIOMS: ALARAiS & SPRIMGS PER CITY CODE
Bar)xr h exam that aril repreamt.&n or expression by eiLber party o nat h(mdiog
unless detected and steed by buyer and seller
P/L
GOLF COURSE
APA SET 8 43'
�—stuns Ext- —�
BBQ
(s¢ ntiwhed detdl)
Eao
Elect.
— — — — — — —
L
decking
i
I
SIDE CONNECrWALK
'WALK I
.l v tis l livb
--, 5I
1Z Lp@ +481,
m
A
ROUGH Fm-cH STUCCO GOLF COURSE m
70 MATCH HOUSE Cal
�P/L I
1c rete
5 a —1210-5,0 L pikrters Ul
�tlCllil��� �
quartzite spil4way
4 5
4 6' m te 101 h" ITOOI
4rit
-- 42'0 —
5PIA
18'0
13'D P/A ( I I 5LFEVE ALL PLANTERS
i 1 Ir
P/A I decking
I
AEEVEALL PLAN1ERS or• F—
F.
SEE EQUIPMENT
74 WALL DETAIL
i P
GATE
bobcat access
REMOTE SWITCH
PALL
4-
14'0
A SMOOTH BAND
TRIM AT PERTJAETER
P/A II
17'0 I
I
I
I
PIA I
�PIA
decking
CT)
CD
BANKSSLEEVE ALL PUNTERS G/E
RESIDENCE
LOT 40 MASTERS SERIES
80-880 WEISKOPF DR
I
I,
f
F On
(31
v
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760-778-2700 760-324-3667 FAX 2295 East Tamarisk Road • Palm Springs, CA 92262 - License No. 779165 M
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