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LICENSED CONTRACTOR DECLARATION
I herebyraffirm 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
Date5X/c/ (s
/ , Signature of Contractor-
OWNER-BUILDER
ontractor
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
1 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`is' 6963 yRg&kers' compensation insurance car.'rier 3 -policy no. are:
Carrier Policy No.
(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 Ip�ya I orthwith comply withose prwrslons.
n.gta•_;" e74 Annlinnnt /t _.11
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 al ove 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 I speoto'n urpose�
Signature (Owner/Agentt)' d�ate
BUILDING PERMIT
DATE
513/96 VALUATION �H:S,it)>U,QQ LOT
JOB SITE
ADDRESS 44-825 Fltt)tYT.ERUA
OWNER
SV1 i'AK. -
44-91:5 FRO911.KRA
LA. QUf't TA, CA.
346-1037
USE OF PERMIT
Pt»►OL'ANDOR. SPA
POOL .AND SPA.014LY
PERMIT # CONTROL #
y .3247
TRACT
APN
CONTRACTOR/DESIGNER/ENGINEER
"S: DODSON
CO 9fRU(�"]'t0�t
688805-REPLEZ, RD, WV9
X2253 CA '.NHi') At., MY CA 922134
(619)3 24-1232 CBU . 1044
V;ST[Wi'rFD COST OF COt4+;5T2hS3MON; ►:>,500.04
ft,34t► ry x11111 SUMMARY
P.LAN'0401x,4.RE; 3111..15
COtgSTRtJC'1I10141'Ir1-: iel_.02)Q�<t2.�t�t)� SI)t.00
iW411ANICIALM! 11 'POOL 101-000471.000
FLEC'M ICAL FUE m- P001, 1-0*4104110
prJuxulNO I?LV --� Pool 101����i:-ar.��i7t�
SUB-TOTikt CONS't'Rt iC'1` ON ANO PLAN CHECK $378J3
LESS PRE -PAID FEES $0.00
'D'OTfill.. ➢'FRMI`4c VE :iL)VE NOW
RECEIPT DAVE-^ �,dn-1 V BY DATE FINALED INSPECTOR
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings .
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI .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
Z
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:
LA QUINTA SET. BACK,ADJUSTMENT
EQUIPMENT IS ADJACENT TO WALL
6" RAISED SECTION
3 SPRAYEAD
12'
5-
281 28'
\14,
3'6
�]w
SPA SPECS. GENERAL SPECIFICATIONS
SIZE 7 SIZE 14X '28 AREA 319
RAISED 6" DEPTH 3'6"x5'x4'
LITE 100 WATTS SHAPE REC PERIMETER 76
TRI LEVEL SEATS TILE SIZE CD 95
22" 24" 27" TILE COLOR CHOICE
DAMWALL WIDTH 6" COPING CANTILEVER
SPILLWAY SIZE 1 X 3"11 COPING COLOR NTRL GREY
SPILLWAY POOL CAPACITY 12500 GALS
PUMP CAPACITY 85 GPM
OPEN x CLOSED — MOTOR HP MAXI II HP 3/4
FILTER MOD MEDIA 300 SQ -FT
FILTER RATE 105 GPM
f TURNOVER 2.5 HRS
SUCTION LINES 1
4' 31 RETURN LINES 2 "
o611 A ESS
WALL BY DODSON
FOR BOBCAT
250 ACCESS
_ * A/C TO BE MOVED PRIOR TO EXCAVATION
R&R BY DODSON, CALL PAULS A/C
_ , T
�r Dodson
W POO/T
SHOW ROOM
73-011 COUNTRY CLUB DR. STE. F-4
PALM DESERT CA. 92260
PHONE (619) 346-4032
LIC # A-574127 OM 9=
MAIN DRAIN 1 "
SKIMMER MODEL. U3
CHECK VALVE YES
HEATER LAARS SIZE 250 OOBTU
GASLINE BY SDC
POOL LIGHT 400 WATT
....... - -.:.. _ .. .SPA
LIGHT 100 WATT
CLOCK' INTERMATIC-
_... _
ELECTRIC BY SDC
ELECTRICAL BONDING BY: SDC
2'
TILE AND COPING SDC
DECKING BY SDC 1043 SQ. FT.
SALT FINISH
CONTRACTOR cannot assume
responsibility .for damage to
�►��_ _ :.
- :-. :.
curbsTsidewalks;.driveways,�,
r
- _
- �. __ _
--
cement slabs, sewers,.
-
lawns,trees, fences, retaining
walls, sprinklers, telephone lines
** TWO PUMP SYSTE�
or shrubs.. When access is made
3/4 HP MAXI II CIFICULATION PUMP
through a neighbor's property it is
2 HP DYNA GLAS OOSTER PUMP
understood that you, the owner,
p
have that neighbor's permission
and assume full responsibility.
Name* ED ZWU'T&%Vl
Addrem 4-4@23
■ ,co ��
sic: ; quoma
o611 A ESS
WALL BY DODSON
FOR BOBCAT
250 ACCESS
_ * A/C TO BE MOVED PRIOR TO EXCAVATION
R&R BY DODSON, CALL PAULS A/C
_ , T
�r Dodson
W POO/T
SHOW ROOM
73-011 COUNTRY CLUB DR. STE. F-4
PALM DESERT CA. 92260
PHONE (619) 346-4032
LIC # A-574127 OM 9=
'tom
DTT OF LA QNTA.
BUILDING SAFETY DEpARTMEN.
CONDIToO®NSTRUC_T'
ACCEPTED FOR'CO
SIJIJEDT To INSTALLATION A5 PER
DATEiAMD ALL APPLICAI3L C® ES -
1��9