0306-506 (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
V It 911555 A ii 00t S/31 /0,*
Date 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 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:
Carrier .''TATE IVIM Policy No. 1689401-2M
(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,,l sb II forthwith comply with thlddprovisions. A
,Date: X - Z <. Applicant—
Warning:
pplicant "�'�s�.r...
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property,for inspection purposes. .„...
/. �. �. _
Signature (Owner/Agent)--!�y'r`r" "'rJ """ " Date 11
. d
PERMIT #
BUILDING PERMIT
006
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS i{ii�%'TI.�t%.r.��AF�
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
+IAXYM WENV Po AK
4258 GOLDEN oA' a
:* :Ups R T KI2%P.r..
DANVILLE CA 94506
PPILM MUK1011 CA 922.62
(=60)7716,4700 UK* 2951
USE OF PERMIT
PnOL ,WINOR SPA
Futu=.,fi, i:6 i k4lali,i 4Ai I -P. W,,1i,1, 1,fs ?
STANDARD ALLAR*;zc.^;IARItIER qrtA.LL.BFiNPi,t*,,�EAr,aRF,.P1'.:t►"$TEf:
FAT;iPFC;TIJ'Di.
.4 xr, W.AU, U00 the
>00L el4?dd IOR, StRA 29,f 4:3,A0 LS
� 'S pie n IE'D COST OF 0011161RU�t:' OR
PLM OYJ,',; K 7919 101.000-409.318 f;P14.9
CC3W:i'C'fs'UC'itM FA''f 101 -0001 -Al 8_000 $AA.50
MECHAWLI. `AL FE, E , tst, 0), 161-LY30-421.00't VAN
FLrV''T9'!;:Af,FW, — P,';c )L 101-000-420.000 $»�.K)
FLU Wi ,1011M -- Y10s ;., 101.000 -As hy0W)
Arg-l`U�:, ,X, MORVIR'JZ`T::OW tNf.) )Ei'I.,k1:C� t�I�4XX
$: 65.41.3
PAD 1 -HMD
Q " 3, *PMryI
$01no
p
L 1°�gtv!T.T .&F.8 DUE NOW
JULEA.l 5 2003
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
I
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 & 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
p
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
.O
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
Gay 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:
limbMWAND MRS STEVE LOCK
80-960 WEISKOPF WAY
La Quinta CA 92253 MASTERS
GF,NFMAL SPECIFICATIONS
DIM NSION& POOL SPA
Ledger 3W(Y' ale,
Widtla: 20'(r 11d'
SmfaceAUm 532 SF 42 SF
Perimeter. 106FT 24 FT
Dzymb: 3'6-A5'I)-x3'6" 42" MAX
Demos
Coacrete: NIA
Sod/Omel: NIA
Plumbima:
Extra Spa to Egolpuneac 40 LF
Raised Spa B)yes Wck valve: YES
Dedicated Vac Lme: YES
Gas LimeExbw 3ULF
Gas Eine farBBQ)Fire Ph: 20 LF
Spa3etv. 4 Back Jets, l Celf• F FoollonSoasoerPmoP
Deekias•:
Celotwrbcoomfinishc 2000 SF DECKING, CAP @RAISED SPA
Cantilever Eche: 106 LF
3-DzdrDraimOff UF): i0'0ONNECTTO870STQd0
Step Riser (Fu LF)c NIA
Dam wall: +18" AND 9' WIDE W/ BOULDER SPLIT
Raired Bond Boma: 26 LP @ +Ir. QUARTZITE VENEER
Umbrulb Slow.: YES TANNING LEDGE & SPA
T JeIsw '
Basi'e 7EIe Grcw: 106 LF 6" GROUP t OR 2 QTZ
Qoartrire6"waaerCuse: YES
Up Trim
TSIs Raised Areas: 0 SF @ DAM WALL, 9 FT STACKED SPILLWAY
IHasoarv:
SPi6way: 9 PT QUARTZITE STAIRSTEP SMLLWAY
WaAerf$B: (3) F8" CUSroM CASCADES (CENTERED)
...�. rr•,ro • ra-a r•vcn t�r.sii i
Fuepit X/A
BaWdem PERDESIGN
AccmWell: RRFORACCESS
BgWpment W a1 411 X 4W
PainUSWccoRlastrr STUCCO EXT. RBB.BACKSIDE
Pool Finish:
albite Pock Plaster NIA
PebbioProL• PEBBLE, COAT- TAHOBBLUE
laatumeml•
Pomp: IIAYWARDN03LTMTAR 1.51iP C CISPA
Pump: SAYWARI)NOR7WSTAR2FPFOR MS
Filter. HAYWARD °t10 SP CARTRIDG-TYPE
He3ter:&4,VWAR0400k BTU LO-N0X
cbnhmtrg - POOLBOSSREbfOf6ll{T.MOU FT
Ba)-Aurd Navigator. smm DEDICATED LINE Al
Pact LiWrt: ONE 401YWATT lY
SpaLiObt ONE IC- -WATT =
Raifical3oo System. AQUA -RIFE SALT SYSTEM
Watt' Peatrre: (1) CU-STOl.1 CASCADES ON RBB PER PLAN bC
Laodscooe: SEE SEPARATE DETAIL
Patio Cover. NIA
Fencma: NIA
AIISC, 5PECIi7CA'FE0 ALARIAS dr SPRINGS PER CRY CODE
Buyer b Mere that oral mprestobwom or expre tau by either party is wt bindms
anless detailtd mod sigmA by buyer aad seller.
golf course
LEaYE D3RT
LAWN WITH MOUNDINGS FOR
oolsoUrr
FOR O VTDCOS
SPEAKERS (2)
BRUSH FINISH CONCRETE
3'o I / I G/E POOL COMROL
EQ UxLL-e
153 IYALK r
E
E 3fceSS I P
16ATE 1t
760-778-2700 760-320-3667 FAX
golf course
LAWN WITH MOUNDINGS
LAKWCAPIN6 156
17'6 MUMS
IRATS® 8014D BEAN ®♦12'
✓FREER QLk4XrZM FAQ ---
JJ /
}
18 EER
ESCENF Ii
•r6 0• 5• 'hti
POOL
3'6a 201)
9' Qawwte 5
4-
9a. t V
3'6'`•
I
I P/A BENac
A5
30'0
za•a
21'9 _
4 7 Ph
' l.r"TA I
HALLOCK
RESIDENCE
80-960 WEISKOPF Y
aFacto PC".
� IEoot Jets I r
Sturm Ent.
-------,UMBRELLA
UMBREUA SLEEVE P/L
LOGGIA
2295 East Tamarisk Road . Palm Springs, CA 92262
License N�l.
D
779165 m
in
I UMBRIIIA SLEEVE
P/L
1
l
I 2B' B
decking
BBQ (see amehed detail)
IInl.
11221
SSA �.
F/A
r
�-rj ---- -- �I SLEEVE ALL
PLANMRS
j
LOGGIA
3'o I / I G/E POOL COMROL
EQ UxLL-e
153 IYALK r
E
E 3fceSS I P
16ATE 1t
760-778-2700 760-320-3667 FAX
golf course
LAWN WITH MOUNDINGS
LAKWCAPIN6 156
17'6 MUMS
IRATS® 8014D BEAN ®♦12'
✓FREER QLk4XrZM FAQ ---
JJ /
}
18 EER
ESCENF Ii
•r6 0• 5• 'hti
POOL
3'6a 201)
9' Qawwte 5
4-
9a. t V
3'6'`•
I
I P/A BENac
A5
30'0
za•a
21'9 _
4 7 Ph
' l.r"TA I
HALLOCK
RESIDENCE
80-960 WEISKOPF Y
aFacto PC".
� IEoot Jets I r
Sturm Ent.
-------,UMBRELLA
UMBREUA SLEEVE P/L
LOGGIA
2295 East Tamarisk Road . Palm Springs, CA 92262
License N�l.
D
779165 m
in