0204-176 (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
Date `' Signature of Contractor L.P,44fe r
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).
O 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
Sec ion 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 3TAT,E C'01,01,019A.'I'1 Policy No. 0460OD6168-01
(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 provlsons. //
Date: i�A_� sa Applicant AA f, :'!P d ,¢'
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 propertyefo"�inspection purposes.. ` t
Signature (Owner/Agent) /t .1r7 e,n Date
BUILDING PERMIT PERM T#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 56-211 �'tDj��FD ���. U
APN
.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
?M ad WAnd ox t?w C1RC=, M)II - I s0
74725 JO DRIVE, U1:311-' 4A �... .
C C)RON,A. CA 91720
PALM I. EM Ck 9 260
USE OF PERMIT
1109L<ANDJORVA
PL''�d3L,P►'°NL'f SPA, O1d1,,i? -OAS ANE P'Itf9 LIRii F1UQI ANS1 %'�1�5 •d94�6.
Dem.
ALARMMARRIERS 5141 U., B i1'3 PIjAC'.E PRIOR TO PRBPLAS'i E
I' 33SPECTT&7N. 1POi:Id.:UQUIPMEF1'f' P14CLOSUlRE 140T EAtC`I.4 ripw nq nf?w"n
POOL "DIOR, SPA U;
" ES- 11 dV.T.A��.''y) COSY OF co.69ZirHY. CITI fN
.8: &7Q�✓y�,`S�iS.B
PXXVfr 1s`K.F SUiil KARY
PLAN 101MICK .SLR 101-t M-43941€ $12,135
C:OWSTR11e:;V014ISLE 101-000-41"00
MEMANI.CA£.• 1NE -- POOL 101.1300-421-000 3�9:f)k1
101-000-420.000 $45,00
MAIMBING FEE w- POOI° 101.000-41,9.000
:1 AL c::0ttrb `1'iG7i23 k'11a fC� C:.4
"AP,R 2002.: -0�F:�kSa`SW. a, ��3:+� Af Y. ir. riasY
CITOFL.AQnl A
FIPIflWCE1]EP'T
11d`JG.`7A315
.
RECEIPT
DATE
BY
DATE FIVALEP
INSPECTOR
124
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
Set Backs
POOLS - SPAS
steel
Electric Bond 3<
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
2—
/J
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Taste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
Pool Cover
Encapsulation
Gas Test
Appliances
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole I I
Underground Conduit
Final S 2l
/��COMMENTS:
/ &r6 LeT-r Tb ��NS G� S�f�►2(L
4" 5T,�MA6S ,
IT, 44"
'?""�
Y 5(� (°3
I vvn
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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SPECIFICATIONS
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ASDL PUMP 512E
SIZE
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TIME GLOGK yES
SlQMr4eR T��L-� TYPE.+.. Flu. LINE E 5
6" LINE � _ STUBS 65, STO
PGt1NTAM5�'3PRAYHtADS —_
SHEER
LIGHTS IN Ft704.'�s"� �'r, IN SPA �SL� (.a
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BEHIND SFA
C12bA11 S
FENCING
FENGt TYPE
►fleHT •
SATE
6ATE REVER9
REMOVE HANG
&UNITE
DEEP END RAMP � D
EXTENDED 2•+d STEP
;Cur'
SI'ILLY1rY
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OW ER RESPO SIBILITIES
OWNER TO, N DETERMINE Tfe APPROXIMATE ELEVATION OF POOL OR SPA AT LAYOUT ON DAY OF MAVATION
W TAKE LOCAL NOTICET TO ACCEPTANCE OF
II ETHAT POOL AM ARTMENT AET TILOCATIONS
t5WAWE E "J
(5)VCT
WET DOM CONCRETE SHELL AT LEAST TYdGE DAILY FOR SEVEN DAYS AFTER SHELL IS INSTALLED
(4) AGREE THAT CALIFORNIA POOLS IS NOT RtS/'ON51Btt FOR Ir?OERhR01�0 GONDITk7NS OR OB,FCTS,
AND ANY DAMAGE TO CLIRD5, SIDEWALKS, DR \I!MY5, LAMS, OR OTHER M45 IN THE AC4ES5 AREA
PS) SEE THAT ALL FENGIN6, 6ATES. AND 6ARABE DOORS MEET LO�GAL CODES FOR A POOL ErGLOSAM
ON
PRIOR FOOL II HIED AATELY AFTERnPLAS
(6) FILL 1 TER irou.ow MSTRUCTIONS - DO NOT USE R1JDiBEIt HOSE)
TAKE NOTICE THAT THIS DRAMN6 IS THE SOLE PROPERTY OF CALIFORNIA POOLS AND THAT ANY
USE M@THOUf WRITTEN FERM?"ON OF CALIFORNIA POOLS, M. 15 PROW NTED B�' LAW.
Kyr
OW"BR APPROVES PLAN, POOL, AND EWPhINT LOCATIONS AAO HAS READ THE RESPONSIBILITIES AND NOTICES ABOVE
O
DATE
SWIMMING POOL PLAN FOR:
_..__..
NAME
-CENT" 2
C)
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'
STREET b —,Z �'�
JOB ADDRESS t�.,
_T' Ch1.`" ?--# i C_ CITY %.� 6)Ij .11r A,
PHONE OFFICE RES
LOT 2 TRACT PAGE BOOK
MAP BOOK PAGE NO. CITY
MAIL ADDRESS
�j
CONSTRUCTION OFFICE PHONE NO.
SCALE
DATE
DRAWN BY
�,
SOLD BY
CHECKED BY
• �
{
,,_- •- _
_
REVISIONS DATE
Z
-L-�►-QMu —
BUILDING &SAFETY DEPT.
APP
CONSTRUCTION
4/�
Rv
5
N
SELECTIONS
.
_
CONSTRUCTION AUTHORIZATION
IS :S FIFI D
�,AI_L.. FMLD
DIG
PRF-GUNITE
W
r�
u
STONE
G-�1n t. �, `a
TILE
-
BOULDERS
DECK COLOR
�, r. I"P,,
JANDY
J `'If
UNDERGROUND
-�-
MA S O NARY
SIGNATURE
DECK
PRE -PEBBLE
DRAINAGE NOTE: Drainage and irrigation for planters and pots, by
others, unless otherwise noted.