0212-157 (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
55 178 0531.37l': (3-8 % 1e 11(V
Date/)" "' Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 6wn6P Ot ine property, ern exuluslvely uuiihaGliny vvilli 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.
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 9*rA.'T1!, i OIyl?S&J3.f TI Policy No. 0466001M# 2
(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 provi�io`ns. �y
Dated ` i ����fi Applicanta�s-�
!
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 personat
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicator 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/A ent er e Date 2- , t .
BUILDING PERMIT < PERMIT#
DATE P, .� --��� VALUATION LOT TRACT
JOB SITE�+t�r��, APN
ADDRESS S,�—��„'�i �V��0ni.>w-p, ••
OWNER CONTRACTOR / DESIGNER / EN (NEER
+'axi Nt i,.1,; 01:,81+ WPAS CAW MAK CO RP
'OAS 1C.Tim ,A CA 922..53 Cr.At•_"•3;UDIU. CAS 92.236
USE OF PERMIT
A14y R NP
P004SPA BPQ(ANS1721--1.199 ;, ltflit� PTT (449.6 A0P.1 ',
1B RI VK%ALAR WRdfl?AjltR EPS SHALL ltd; )N M -ACE AT P. R,PLAS'€RA
INSPECT011. WU19 M?,1\tT 34'PdCLOSURIP 140T INCLUDED
POMANDIOR SPA
2810KI100 LZ
]KINMWIN11.1, COST 11111, MONIMMIUVWX
PIAN CHECK iIF., 101-6tV-439-318
C ONSTRUCi'1014 rfE 101-000-418-000
MECHANICAL ME -- POOL 101.000-121.000 r2AM
VLEt.. VXIC.Ai..'V7�t — P'00.1, 1011-000420-000 $4:51?9
PLU t,3Bma Ff lr -- POOL. 101-00%,,-419-000 -419}006) rV.0
LJ�
DEC 2 R 2002
CITY OF LA QUINTA
LF2119 PRE -PAID F=-3
.A-L.?E:1 N4J -54T1N9 DMI, NOW
BY
DATE FINALED I INSPECTOR
` 43.04
$0100
Z43M'
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
POOLS - SPAS
Steel
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 Final
Water Piping
Plumbing Final
Pluml ing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Cc^'.inection
Encapsulation
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:
` = PATRELL.
ENGINEERING
GROUP, INC.
651 E. Northridge Ave. • Glendora, CA 91741 • PH; (626) 335-4362 • FAX: (626) 963-4812
ENGINEERING CALCULATIONS
AND DETAILS FOR
SURCHARGED POOL WALL
W/ BRIDGE DETAIL
ESTANCIAS LOT # 34
50-355 WOODMERE
LA QUINTA, CA
0
LNo. C32994 m
Exp. 6/66
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OF
CITY
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DA 't, 2 BY L3
DATE: DECEMBER 19, 2002
ENGINEER: DOUGLAS R. FERRELL
RCE # 32994, CALIFORNIA
651 E. NORTHRIDGE AVE.
GLENDORA, CA 91741
(626) 335-4362
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Project: �� G NL7
PATRELL
ENGINEERING
GROUP, INC. Engineer:
651 E. Northridge Ave PH: (626) 335-4362 Date: 2� �`� oL ShEet of
Glendora, CA 91741 FAX: (626) 963-4812 �— —
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ENGINEERING
GROUP, INC.
651 E. Northridge Ave PH: (626) 335-4362
Glendora, CA 91741 FAX: (626) 963-4812
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Project:
PA9MELL
ENGINEERING Client:
GROUP, INC. Engineer:
651 E. Northridge Ave. PH: (626) 335-4362
Glendora, CA 91741 FAX: (626) 963-4812 Date:
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Project:
`+ PATRELL
ENGINEERING Client:
GROUP, INC. Engineer:
651 E. Northridge Ave. PH: (818) 335-4362
Glendora, CA 91741 FAX: (818) 963-4812 Date:
s ZZC.'k A7 -AE 'Pca, WAIL
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Project:
PATRELL
ENGINEERING Client:
GROUP, INC. Engineer:
65.1 E. Northridge Ave. PH: (818) 335-4362
Glendora, CA 91740 FAX: (818) 963-4812 Date:
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City of La Quinta Building and Safety Department
Plan Check Corrections
tructual',
Estancias Lot #34
50-355 Woodmere
La Quinta, California
Engineer: Douglas R. Ferrell
Plan Check No.: 0212-151(1St check)
Date: 12/24/02
1. "Standard pool plan" shall specify all construction materials and specifications as noted on
page 2 of the structural calculations and detail submittal.
Please incorporate requested corrections into plan sets and reprint.
Plan Reviewer. John W. Thompson, P.E.
Phone No.: 760-360-5770 (ext. 102) Fax No.: 760-360-5719
r