0308-188 (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
07131 /2K
Date, >I tfo:�Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l am exempt from the Contractors
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 3-rAT& FUN,.) Policy No. 046020010151
(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' compensationprovisions of Section 3700 of the Labor
Code, �hshtall forthwith comply with those p1ovislons.
Date: 1110' Applicant—
Warning:
pplicant 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,jand State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
it the above-mentioned property for i spec��tion purposes.
Signature (Owner/Agent)'-" L Date
BUILDING PERMIT PERMIT#
•DATE rVALUATION LOT-'� ' TRACT
JOB SITE APN
ADDRESS m.9.7o it F Ci -
OWNER CONTRACTOR / DESIGNER / ENGINEER
M/M ROBERT DIC" RZY CI RUJILA POOL C0MM1J 0N, )NC.
90.970 WMMOPT' 78-710 LA, PALMA DR, LA Qx3 NTA
L A QL3'XIA. M 9.2253 PALM DESERT CA 9226 i
(760)360»6602 CM1.9 1844
USE OF PERMIT
POOL AND/OR SPA
POWSPA, BBQ. AL1RMS(RARRIERS SHALL BE Ild MSTIA LED PRfOR.
TO PRIG; -PLASTER lKSPECT10-4
POOL A?iDIOR SPA
31"5000100 Lo
E'SUMAM COV. OF CONS'f.RUM4: N
�'�,(ltlt►
PERAM YET. SM wiA:Y
PLAW CHECK "M
101 -000439-318
$206.05
covs'rRuCTIOX FZE
101-000-416-000
1317.00
MECkIANICAL FEE -- FOOL
101-000.421.000
12440
ELECTRICAL REAZ — POOL
1.91-000-4.20-000
$45.00
PLUMBINQ FEE - POOL
1031-000.419.000
$27,00
9M -IOTA«.. COtrlKR.i:ic'.TdO AM) PLANCMS:.
LE35 PRE-PAIr, FERS
I'"1?�4"�JCI I�'1E"S DX73f iVClW
AUG 2.1 2003
CITY OF LA QUINTA
RECEIPT I DATE -� - IBY C�I DATE FINALED [INSPECTOR
$6113. bl
$0.00
5619-u.s
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
OX 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
Steel
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Electric Bond
ootings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
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
L Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
r
x
FIXTURE
COMMENTS
10
G
5PJ 1_16HTIN6 INC - SPJ-804-GN 50W MR -I6
PALM TREE EI)LLET TYPE UP -LIGHT
2'x2'xl' ± 1/4 ton
I
7--7--7-7-1
35
LIGHTING LEGEND
0
C)
QTY.
SYM.
FIXTURE
COMMENTS
10
G
5PJ 1_16HTIN6 INC - SPJ-804-GN 50W MR -I6
PALM TREE EI)LLET TYPE UP -LIGHT
2'x2'xl' ± 1/4 ton
CAST ALUMINUM 015T d LOCK COVER)
VV NATURAL COPPER FINISH
4
b4tg
5PJ LIGHTING ING - 5PJ-G04-GN 35W
UP -LIGHT FOR TREE GANOPT / FLOOD LIGHT
CAST ALUMINUM (TWIST S LOCK COVER)
VV NATURAL COPPER FIN15H
6
5PJ 1_16HTIN6 5PJIO-01 18W
INCANDESCENT LAMP,
NALKL16HT DIREGT TOWARD5 PATH/ DRIVE
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Cy d V
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W/ NATURAL COPPER FIN15H
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TRANSFORMER BY JUSTIN, INC.
5TAINLES5 STEEL ENCLOSURE
4
MODEL NO.MTP-330-TP 300 MATT - II -15V -
10"W x I2"HT x 6" DEEP
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BUILT IN PHOTO -CELL AND TIMER
ds
LIGHTING NOTES:
ALL FRONT YARD FIXTURES ARE TO BE ON SEPERATE CIRCUIT WITH AN ON/OFF
PHOTOCELL. THE REMAINNG FIXTURES SHALL BE ON SEPERATE CIRCUIT AND
SHALL BE ONYTIMER OFF.
5E7BACK N07E5
Locate light fixtures a min. of 4'-®" from edge of tree
Locate light fixutres 1'-0" from edge of polms
At all times a conscious effort will be made to place
light fixtures in planter beds ins'teod=of lown areas.
These measurements are superseeded only when f ie Id
conditions warrant change by Landscope Designer.
HEADERBOARD NOTE:
Landscape Contractor shall install'Trex' or equal 1/2" x 4" products for
seperation from lawn to shrubs beds. Use slakes at b'-8' on center.
BOULDER NOTES:
Boulders are to be smooth gray granite varying in size from 25(3'
to AN. Boulders are identified on landscape plan by letter, 'A'
being the largest and'D' being the smallest. Landscape contractor
to vary the sizes and heights when placing boulders in clusters.
Boulders to be buried no less than 1/3 of their height upon final
grading.
MOUNDING NOTES:
Mounding to be done in -field at Landscape Designer's direction
w/ mounds not to exceed 48' in height above surrounding
sidewalks and PAD elevations.
B®ULI'�E-R SCHEIULE
SYMBOL SIZE
A
3'x4'x2' t 1-1/2 tons
B
2'x3'x2' t 3/4 ton
G
3'xl'x2' ± 1/2 ton
D
2'x2'xl' ± 1/4 ton
LANDSCAPE MAINTENANCE NOTE:
ALL FRONT YARD LANDSCAPE TO BE MAINTAINED BY
PGA WEST ASSOCIATION'S LANDSCAPE MAINTENANCE
PROGRAM.
ALL OTHER RESIDENTIAL LANDSCAPE IS TO BE THE
RESPONSIBILITY OF THE HOMEOWNER TO PROVIDE
"APPROVED" LANDSCAPE MAINTENANCE SERVICE
L 3 i 'iGiL�
I I'i; �diYni
PLANT LEGEND
TREES
5YM. NAME 51ZE QTY. COMMENTS
GPX Cercldlum praecox 36" box
Sonoran Palo Verde
GIT Citrus Species 15901 to be selected
Dwarf Citrus
FM Fortunello margarita 15 gal.
Nogami Kumquat
OE Oleo europea 36" box
Swan HiI I' f=ruitless Olive
ML Meloleuco quiniquervio 24" box
Ga jeput Tree
PK Pyru5 kowakomii 36" box Standard
Evergreen Pear
RIM Rophiolepls Indica 'Majestic Beauty' 24" box
Rophiolepis tree
5T 5chinu5 Terebinthefolius 24" box
Brazilian Pepper Tree
TP Thevetla peruvlano 48" box Multi -Trunk
Japanese oleander 'Apricot'
PALMS
5YM. NAME 51ZE QTY. GOMMENT5
GR Cycas revoluto 24'' box (heights vary) 2
5090 Palm
GH Chbmaerops humilis 24" Box Multi -Trunk - FULL
Mediterranean Fan Palm
o PO Phoenix dactyllfera 25' ht. Matching "DIAMOND GUT"
Date Palm
PR Phoenix roebelen11 15901 Coachella Valley Nursery ONLY
P1gmy Date Palm
5HRUB5
5YM. NAME 51ZE QTY. GOMMENT5
OAgaponthus africonus I gol.
Lily of the Nile
OAsparagus densiflorus sprengeri 'Myers" 5 gal. 52
Myers Asparagus
Bougainvllleo 'La Jolla' 5 gal. 16
Bougainvillea
OB Buxus microphylla japonica 5901. 21
Japanese Boxwood
OGorissa grandifloro 'Boxwood Beauty' 5 gal. 15
Boxwood Beauty Natal Plum
OGardenia jasminoides 'Veitchii' 5 gal. 12
Veitchii Gardenia
OHemerocallis hybrid 5 gal. 53
Day Lily
Hibiscus rose -sinensis 15 gal. 16
® Hibiscus MIXED COLOR
0 Ligustrum japonicum texonum 15901. 4
Naxleof Privet
Moreo bicolor 5 gal. 32
f=ortnight Lily
ONandina domestics 'compacta' 5 gal. 22
Compact Heavenly Bamboo
Pittosporum tobira 'variegate' 15901. 3
Variegated Mock Orange
OPittosporum tobira 'wheelerl' 5 gal. 12
Dwarf Mock Orange
ORhophiolepis indica ballerina' 5 gal. 23
India Howthorn
Rhaphiolepls Indica 'springtime' 5901. 12
India Hawthorn
O5trelitzia reginoe 15 gal. 7
Bird of Poridise
Trocheiospermum josminoides I gal. 13
o Star Jasmine
E5PALIER5 8 VINES
5YM. NAME SIZE QTY. GOMMENT5
BBK Bougainvillea 'Barbara Karst' 15901. 12 Vine
Bougainvillea
GI Galliandra inequllotera 15901. 3 Espalier
Pink Powder Puff
GROUND GOVER5
5YM. NAME 51ZE QTY. GOMMENT5
LAWN L Hybrid Bermuda 'Old Line Tifdworf'
AG Annual Color flats IO" O.G.
To be selected by Owner
D6 To Be Selected By Owner 2" THICK
DENOTED TREES WITHIN 10 FEET OF HARD50APE, WALLS OR BUILDINGS TO
RELIEVE 3DEEPROOT' ROOT BARRIERS PER MANUFACTURER'S SPECIFICATIONS
NOTE: ALL OUANTITIE5 ARE FOR ESTIMATE PURPOSE ONLY.
CONTRACTOR TO VERIFY QUATITIES.
eVINE GALLOUT e TREE CALLOUT
NOTE: ALL MOUNDING, HEADERBOARD, STEP STONES, TREES,
5HRU55, BOULDERS, AND LIGHTING TO BE FIELD APPROVED
BY LANDSCAPE DESIGNER PRIOR TO INSTALLATION.
FFIN15H GRADE
ALL CAVITIES AND VOIDS
i „yr_*-, e b A *-,= ARE TO BE BURIED
- � FINISH GRADE
11LII=_ =III
-111ii1-11111=11111-111111=111111-11T�
LEVEL GRADE ALL CAVITIES AND VOIDS
NOTE: ARE TO BE BURIED
BOULDERS IN CLU5TER5 ARE
TO BE SET AT VARIED HEIGHTS
CITY OF LA QUINTA
BUILDING &SAFETYDEPL
APPROVED
FOR CONSTRUCTION
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