0310-102 (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
;:'3:.`1 C Fy(if 31 "),
DateSignature of Contractorrei. `-
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.
(J ,),,,4have 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 IrrJ h`L, f3�;� F1N1•ISAXI Policy No. &1$6 bXl�Lt : Ott,
(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 p�v((isions of Section 3 00 of the Labor
Code, I shall forthwith comply with those povlsiorls. %
Date: 1 '.P Applicant f'. l
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 asa 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 ofthis City to enter upon
the above mentioned property for inspec on p rpo es. /
Signature (Owner/Agent) y/ Date `•� r'�✓�
PERMIT #...
BUILDING .
.PERMIT C4�10•-102
DATE VALUATION tt�"` � LOT- TRACT '
s'
JOB SITE!
ADDRESS'�k. t`Ps';s1F�
APN
— .
OWNER .
CONTRACTOR / DESIGNER / ENGINEER
ESCIONDMO CA 92MS
(:"OAC €-TE?,LLA CA 924-36
USE OF PERMIT
•((��
TIIOC+L i�iNDIOR. iiF 1A
a,++�:+&ea�t;�. r 3 t.•, ��. a xa �:.>E..h.. u�x•►� � t., c x r� i.r�: �:�s:su.:.
.I�:F•114 f'fAC:V,itX.1LRFAIL,A9H'?'."ZIN's _K'TION'i
POOL, Ail liXS. 3PA i I-,.760, to
4 . Gv.Q;t:i, 15. Ti) it
1'W N GHWX PIKE, S1 P7:90 .
CQXvISTRXIt.VOl� ,T .F.E. A C3i •.iiiai?-41 ^Qi O �f8k3.tfii'
1V. ZCIiAWICAL 1°`R,:i:..,YOC)l.; 101 ,1000-421-000 %�4•@dl
D •
NOV. 2003
OF LA QUIN` A
CITY
yFINANCE♦ TDtgE.7P�T�. v. p
• AY7 C':i^81.r•A.'�'i'Vn,.•l1OSC.p,;/.dS.Z1 a:'dOnl�Tm111 PLAN CH%=.
r.. ,0 0.
RECEIPT
DATE o r ^�
BY ' tt
E FI D
PECTOR
Kai.
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 imp
Underground Plbg. 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
C" -
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: -
SPECIFICATIONS
TYPE G /'V TT F-- , SIZE X
SURFACE AREA OF POOL I L
t0 �
rn
PERIMETER DEPTHS MIN. t MAXCO
C N
N C
SPA SPECIFICATIONS TILE
SIZE 7' X SO. FT. TILE TYPE v
SPA DAM WALL WIDTH WATER LME J
NO. of JETS TILE TRIM wN
LIGHT QUARTER ROUND V Q to
RAISED SPA AT -12
1 R.B.B. 00
SPILLWAY TYPE i' G �` t� f, f 14E V NO
It N Z
SPECIAL NOTES h N
DECKING coI Z
sa Fr PSP? a w
PO
,4T C: Y•:+.? '„ !'r:_! �r �r EXCAVATION /STEEL FINISH 0
0 p
ACCESS FROM EXPANSION JONTS V
I '�
ELEVATION CANTILEVER c v
DEEP END RAMP DECK DRAINS d
LOVE SEAT DECCO DRAM
CONCRETE REMOVAL LOADS CURB CORE .
SOO REMOVAL LOADS STEPS
TREE REMOVAL BY STEP FACE
I?RIGATION REMOVAL BY TILE BASE
` IRRIGATION REPAIR SAND ANO VISOUEEN
6' R.8.8. ft RIBBONS
?�f Gr-vlA `z, r 12• R.R.B. MOW s'RIP
16• R.B.B. >R.
24• R.B.B. ft
t:_ _-- - - --- - ------_ _: __ . _... - 30' R.B.B. ft
TAN SHELF DEPTH
ocKETs
MASONRY
ROCK P
COPING TYPE
CENTERS R.B.B. FACING
SPILLWAY TYPE SZE
PLUMBING STEPS
FILTER SIZE PROP. EXT. WALJ.S
POOL PUMP SZE PLANTER MALL
RETAINING WALLS
BOOSTER PUMP SZE EQUIP. WALLS
"4 ADD`L PUMP SZE FIREPIT
ADD'L PUMP SZE
} HEATER SIZE
`+-w t ✓� \ .�'"� ,x, A.,.. �( j`.
TIME CLOCK �
SUB PANEL
ADDI OU
SKIMMER TYPE
FILL LINE PEBBLE PLASTER
GAS LINE SIDS LIGHTS POOL
LIGHTS SPA
�� q,_ j {-✓� r fWNTA NS/SPRAYHEADS BOLTED BOND BEAM
1 Y fV•, E-✓-+ BEHIND SPA
SHEER DES
. EYEBALLS
LIGHTS IN POOL IN SPA
STUB SET EOUIPMENT FENCING-
MISC.
FENCE TYPE
PLUMBING SIZE p
HEIGHT '
GATE
GUNITE GATE REVERSAL
DEEP END RAMP REMOVE & REHANG
EXTENDED 2nd STEP
LOVES AT
SPILLWAY TYPE EST. START
CANTILEVER EST. COMPLETION O Q
3
COPING OTHER
R,B.B. - SEE STEEL
6WN7R R7SPONSIBILI
OWNER TO: (1) DETERMINE THE APPROXIMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY OF EXCAVATION
(2) TAKE N0110E THAT POOL AND EQUIPMENT LOCATIONS ARE SUBJECT TO ACCEPTANCE OF
LOCAL BUILDING DEPARTMENT AT TIME O< ISSUANCE OF PERMIT
(3) WET DOWN CONCRETE SHELL AT LEAST TWICE DAILY FOR SEVEN DAYS AFTER SHELL IS INSTALLED
(4) AGREE THAT CALIFORNIA POOLS IS NOT RESPONSIBLE FOR UNDERGROUND CONDITIONS OR 08JECTS.
AND ANY DAMAGE TO CURBS, SIDEWALKS, DRIVEWAYS, LAWNS, OR OTHER ITEMS IN THE ACCESS AREA
(S) SEE THAT ALL FENCING, GATES, AND GARAGE DOORS MEET LOCAL CODES FOR A POOL ENCLOSURE O
PRIOR TO PRfPLASTER INSPECTION
(6) FILL POOL IMMEDIATELY AFTER PLASTER. (FOLLOW INSTRUCTIONS -- DO NOT USE RUBBER HOSE)
(7) TAKE NOTICE THAT THIS DRAWING IS THE SOLE PROPERTY OF CALIFORNIA POOLS AND THAT ANY
USE WITHOUT WRITTEN PERMISSION OF CALIFORNIA POOLS, INC. IS PROHIBITED BY LAW.
`;OWNER APPROVES PLAN, POOL, AND EQUIPMENT LOCATICNS AND HAS READ THE RESPONSIBILITIES AND NOTICES ABOVE. �
SIGNATURES) DATE
SWIMMING POOL PLAN FOR:
NAME GREEN RESIDENCE
0
STREET_ (, a:;, >a �'�.-e wt04sro •—
JOB ADDRE ICITY
PHONE OFFICE RES
LOT 1 '1 TRACT 1't-7?,S PAGE BOOK
MAP BOOK PAGE NO. CITY
MAIL ADDRESS
CONSTRUCTION OFFICE PHONE NO.
SCALE, DATE DRAWN BYSOLA BY CHECKED BY
1/8 =1 IQ—?—L�3 .�., • rv�.<� ,fir t`� o
JOB# REVISIONS
DATE
1
- NSPEGT GNI--fE"F_$
2 v�f 111 BE CHARGED IF THE APPROVED
ND jOB-C-ARE—ARE-NIQON
3 fl -IE SITE FOR A SCHEDULED
Y31
ul
Lull
NO EXCEPTIONS!
w
z
w
0
CONSTRUCTION AUTHORIZATION
T
SPECIFICATIONS
TYPE G /'V TT F-- , SIZE X
SURFACE AREA OF POOL I L
t0 �
rn
PERIMETER DEPTHS MIN. t MAXCO
C N
N C
SPA SPECIFICATIONS TILE
SIZE 7' X SO. FT. TILE TYPE v
SPA DAM WALL WIDTH WATER LME J
NO. of JETS TILE TRIM wN
LIGHT QUARTER ROUND V Q to
RAISED SPA AT -12
1 R.B.B. 00
SPILLWAY TYPE i' G �` t� f, f 14E V NO
It N Z
SPECIAL NOTES h N
DECKING coI Z
sa Fr PSP? a w
PO
,4T C: Y•:+.? '„ !'r:_! �r �r EXCAVATION /STEEL FINISH 0
0 p
ACCESS FROM EXPANSION JONTS V
I '�
ELEVATION CANTILEVER c v
DEEP END RAMP DECK DRAINS d
LOVE SEAT DECCO DRAM
CONCRETE REMOVAL LOADS CURB CORE .
SOO REMOVAL LOADS STEPS
TREE REMOVAL BY STEP FACE
I?RIGATION REMOVAL BY TILE BASE
` IRRIGATION REPAIR SAND ANO VISOUEEN
6' R.8.8. ft RIBBONS
?�f Gr-vlA `z, r 12• R.R.B. MOW s'RIP
16• R.B.B. >R.
24• R.B.B. ft
t:_ _-- - - --- - ------_ _: __ . _... - 30' R.B.B. ft
TAN SHELF DEPTH
ocKETs
MASONRY
ROCK P
COPING TYPE
CENTERS R.B.B. FACING
SPILLWAY TYPE SZE
PLUMBING STEPS
FILTER SIZE PROP. EXT. WALJ.S
POOL PUMP SZE PLANTER MALL
RETAINING WALLS
BOOSTER PUMP SZE EQUIP. WALLS
"4 ADD`L PUMP SZE FIREPIT
ADD'L PUMP SZE
} HEATER SIZE
`+-w t ✓� \ .�'"� ,x, A.,.. �( j`.
TIME CLOCK �
SUB PANEL
ADDI OU
SKIMMER TYPE
FILL LINE PEBBLE PLASTER
GAS LINE SIDS LIGHTS POOL
LIGHTS SPA
�� q,_ j {-✓� r fWNTA NS/SPRAYHEADS BOLTED BOND BEAM
1 Y fV•, E-✓-+ BEHIND SPA
SHEER DES
. EYEBALLS
LIGHTS IN POOL IN SPA
STUB SET EOUIPMENT FENCING-
MISC.
FENCE TYPE
PLUMBING SIZE p
HEIGHT '
GATE
GUNITE GATE REVERSAL
DEEP END RAMP REMOVE & REHANG
EXTENDED 2nd STEP
LOVES AT
SPILLWAY TYPE EST. START
CANTILEVER EST. COMPLETION O Q
3
COPING OTHER
R,B.B. - SEE STEEL
6WN7R R7SPONSIBILI
OWNER TO: (1) DETERMINE THE APPROXIMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY OF EXCAVATION
(2) TAKE N0110E THAT POOL AND EQUIPMENT LOCATIONS ARE SUBJECT TO ACCEPTANCE OF
LOCAL BUILDING DEPARTMENT AT TIME O< ISSUANCE OF PERMIT
(3) WET DOWN CONCRETE SHELL AT LEAST TWICE DAILY FOR SEVEN DAYS AFTER SHELL IS INSTALLED
(4) AGREE THAT CALIFORNIA POOLS IS NOT RESPONSIBLE FOR UNDERGROUND CONDITIONS OR 08JECTS.
AND ANY DAMAGE TO CURBS, SIDEWALKS, DRIVEWAYS, LAWNS, OR OTHER ITEMS IN THE ACCESS AREA
(S) SEE THAT ALL FENCING, GATES, AND GARAGE DOORS MEET LOCAL CODES FOR A POOL ENCLOSURE O
PRIOR TO PRfPLASTER INSPECTION
(6) FILL POOL IMMEDIATELY AFTER PLASTER. (FOLLOW INSTRUCTIONS -- DO NOT USE RUBBER HOSE)
(7) TAKE NOTICE THAT THIS DRAWING IS THE SOLE PROPERTY OF CALIFORNIA POOLS AND THAT ANY
USE WITHOUT WRITTEN PERMISSION OF CALIFORNIA POOLS, INC. IS PROHIBITED BY LAW.
`;OWNER APPROVES PLAN, POOL, AND EQUIPMENT LOCATICNS AND HAS READ THE RESPONSIBILITIES AND NOTICES ABOVE. �
SIGNATURES) DATE
SWIMMING POOL PLAN FOR:
NAME GREEN RESIDENCE
0
STREET_ (, a:;, >a �'�.-e wt04sro •—
JOB ADDRE ICITY
PHONE OFFICE RES
LOT 1 '1 TRACT 1't-7?,S PAGE BOOK
MAP BOOK PAGE NO. CITY
MAIL ADDRESS
CONSTRUCTION OFFICE PHONE NO.
SCALE, DATE DRAWN BYSOLA BY CHECKED BY
1/8 =1 IQ—?—L�3 .�., • rv�.<� ,fir t`� o
JOB# REVISIONS
DATE
1
- NSPEGT GNI--fE"F_$
2 v�f 111 BE CHARGED IF THE APPROVED
ND jOB-C-ARE—ARE-NIQON
3 fl -IE SITE FOR A SCHEDULED
Y31
ul
Lull
NO EXCEPTIONS!
w
z
w
0
CONSTRUCTION AUTHORIZATION
w
w
w
Cc
�6
/-7 1 C,5/
SELECTIONS
STONE
r
SALES
FIELD
TILE
bOULDERS
-
DIG
DECK COLOR
` \h `y" = .`'-,,.�1:� ,
PRE-Gt.'11I'I'I:
DANDY
l.TNDI RGROUND
PEBB./PEAS
MASONRY
SIGNATURE
DECK
DRAINAGE NOTE:PRI=-PEI3I3LE DRAINAGE NOTE:
and irrigation for planters and pots, by
others,
others, unless otherwise noted.
F)RE-PE13131-F