0109-121 (RPL)aLICENSED CONTRACTOR DECLARATION
I' hereby affirm underpenalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
ProfessionaleCbde, and my. License is in full force and effect.
License # Lic. Class Exp. Date
574127 ---;-A C33 011W13 �2C
Date %°�"�� %' `� Signature of Contractor K
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).
( -) 1, 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 Policy No.
STATE tr`UND tiJ�t� �d tlilii'?Sf�
(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 shallyforthwith comply with those:proj !sibrIse
,/Date: aa•" �` � %� � Applicant--..
Warning: Failure•to secure Workers'4po p nsation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,:ih
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 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/Agent) Date �'_�:•'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (J109,_J.2•A TRACT
� CB41Ei.f:�3
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEEF 1
LUE, RMEN
MWE ElO DSON t"ONSIMUC'::'.COla 01C.
"ds•���""a ' : t"'�fa'F�i Z�:fz,%�.�
� ��s � i �:i>�'N'1:��' �:t�t7"u?� �7�., klt:i�`,I"� I�4
%:A92253
PALM.DRIS 0.111 CA 92260
'
USE OF PERMIT
:+fit? kiL ANDIOR 0.4,
POCIa ISPA, - POMMI'T ro093 NOT aNGa,1.iDE 31.00K INAL.:U.POOL
FMCi.rt.1SUM AIARM ARP RS MUST 13P,134 PLACE, AT PREPTAS'1 EM,
5100J, P NWOR SPA hg�6i3�.pfi 1R:
' 7f: '�.% CO15'1' Of., IGfi,JNir"IR'I.rC." .fit" N
231000 -OD
PERWr FIN WKNARY
PUN C119C9 MY., 101.000-439.318 $176A8
CONSTPUC` ICHRIZ 101-000-418-•000 $271,50
MIC1 ANICA,.1,1i% ••- POOL 101-000-421-000 $24.00
lu'b.,Ef���'1•�'jt.i�r'AL,(iir E, — POOL 101-000- 20-000 $43.00
PLU_VOOL 101-000419,-000 VIM,
ttTC"°Czk3vx23 ] f�igZ �°4I;GT4_�4,
114_5S TYRE P•AiID IRT.Y S
3:33
$0.00
,
S:P�117 2001 CM, FEW.-��V013DIMI,ro
CITY OF LA QUINTA
FINANCE DEPT.
w .
'
RECEIPT
DATE `
BY
DATE FINALED
INSPECTOR
yj
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fc. s & 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 Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS_
Set Backs
steel
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electrjc
Underground Pibg. Test
Final
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Q v�
PLUMBING APPROVALS
Waste Lines
Water Piping
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
.
hB G:O�
COMMENTS:
-
y
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. r<
Smoke Detectof`s
Temp. Use of Power
Final
Utility Notice (Perm)
- r CONTRACTOR cannot assume responsibility for damage to GENERAL SPECIFICATIONS
curbs sidewalks "driveways cement slabs sewers lawns trees
STACKED WATERFALL , LA QUINTA HOMES fences. retaining walls. sprinklers, telephone Iines or shrubs. SIZE 15 X 36
CA
W /ROCKY MOUNTAIN QUARTZ &CAP FOR CASDE MUDSILL CROSSECTION
LAYOUTDESIGN &ELEVATION APPROVED AREA 420 PERIMETER . 96
BY OWNER OR OWNER'S AGENT: DEPTH 3' X 5'
WAn2LM
7OP d DA.N WALL
HOUSE r
H
OICE GROUP 3 SQ. 65
MUD SILL TILE C_
a
"
'< DATE
RBB.
32 OF 12
DECK
. -`
signature
2" BELOW SQLW
COPING CANTILEVER
-18" WIDE:: '
GALS
SPADAI WALL:: P00L APA ITY 12000
LAE�E
ga : .: P P
MP CAPACITY GPM
U C CI
102
�>�...... ON BOND BEAM
RETURN:: ::6oicvziec::»=::
>`4 ... :.:.::::.:..::..:: PMP 1 STA RITE 1.5
rnvEwmt:: ::i:s TILE AT WATERLINE
U # HP
ccx vaLvs
s3 l
STRIP FORMS FOR FINISH
° STUC'C'O TO MATCH HOUSE - FILTER STA RITE 300 SQ FT
t t - FILTER RATE 102 GPM s
.. - HEATER STA RITE SIZE 400 BTU'
SLEEVE ALL PLANTER - . - OUBLE CANTILEVER CAP
' - y`r I TURNOVER - .4` HRS {
P/L 2 „
EXISTING PLANTER WALL SUCTION LINES
P/A 31' 611 X 6f-8" P/A _ RETURN LINES, 2
- .5'-6"SKIMMER MODEL AMERICAN
- - - h12' CHECK VALVE YES
y
` GASLINE BY SDC FT. 110
8' P/A POUR IN PLACE POOL LIGHT 400 W CLOCK AQUA
• rr, - `I 19.2" CURB +6 ELECTRICAL BY. SDC FT. 300
G/E STUBOUTt „ - - AUTO CLEANER GREAT WHITE
1
FOR SHELL - 41' 6 " ;39-0" _ ��\ ` _ , .,
BOTH BY 24'-0 �'# SLEEVE ALL PLANTERSF PLASTER COLOR PEBL DOLHIN BLU
OUTDOOR INV ' _ ,
S io^ R3f-6" DECK BY SDC SQ. 1342
STEP TRIivI ON ! •� o \ /. y X CALIFORNIA EDGE
TILE TO MATCH
TANNING LEDGE ONLY — _ - DECK TYPE _ SALT -COLOR TBS
POOL/COOK UNIT / - FREESTYLE ' _ - TYPICAL
32'-4" . \ THIS AREA 24'-6",
PROVIDED BY si✓ SPA SPECS.
OWNER R8'-0" --J \
16'-7" PATIO COVERS RANDY SIZE T RAISED +18"_
'
PATIO COVER BY HU AWMN •IT LITE 100 WATTS
r ti `::::DAVE.:.:;>: RI LEVEL SEATS 22" 24" 27"
_ OV P/A " - _ DAMWALL QUARTZITE
09/08/01 DAMWALL TOP QUARTZITE
' - - P/A - •� >REUFSED: SPILLWAY SIZE QUARTZITE WIDE
'almoM SPILLWAY XX OPEN CLOSED
03
SLEEVE ALL PLANTERS C C'7 09/12/01m,,, % f� _ _ _ Tl #JETS 4 UPPER LOWER
A - y �y r F� � 0 Name: LEE AND JAN RYSDEN
arca} Sic �Irtort(I �nl �,l /� �` � 1 '?' CT ASiSiL� 78-865 ZENITH DR.
UA //�, �O F 4' 0� a_ Z 90 cLt}C; LA QUINTA
AQUASWITCH.Cw�/-o 'O �C 2'-0" t-
� •. �^9 �0 ',��`'7J _nJOB# :Fmi'
:� �' • . y - CF�OT CSS' FD n—+ 1 rn
TRACT STARLIGHT DUNES • LQ -T-# 11 ;
r.•i . ��Vr 7xC F� 6'6 Z # '. f J�odson
Pools
BOBCAT •1s1 —
ACCESS }*:' — �® PALM DESERT TEMECULA ;
NO R/R -_ - slew '�'I 4 •�Y�'- ;r ��s�� 73-01 1 COUNTRY CLUB DR. -'28910 RANCHO. z
_• �� _ _ _ : — - --- s'. PAGE 1 OF 2 SURE F-4 `. CALIFORNIA RD. SUITE 203
USE DOUBLE I _ ' }} -�►�$ I ��I' I = - PALM DESERT CA. 92260 TEMECULA CA. 92590
GATE FOR ACC Slt� Y (V 1 �.. 1 S [RC�G71�TiiI�� �P III 1/8"-1' SCALE (760) 346-4032 (909)676-7946
_ �..� I 1•-'"1 fi l LIC # A-C53-HIC-574127
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