0305-217 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed' under provisions of
Imo— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
o ZF ?'
Date jg�fs� Signature of Contractor—,
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CD _ �.�
J U C) OWNER -BUILDER DECLARATION
HWW r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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 offerd 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
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N Date Signature of Owner
Q N
O)
IL Q WORKER'S COMPENSATION DECLARATION
C) Cc I hereby affirm under penalty of perjury one of the following declarations:
Q () 1 have and will maintain a certificate of consent to self -insure for workers'
X W I= compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U (�tS I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Cartier S ?+Tf FUM0 Policy No.
0
(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
3` Code, I shall forthwith comply with tho"se;� revisions,l,»,
e.Dafe: vxr�'•d Applicant ;" ! f VQ*,✓s X
Warning: Failure to secure Works' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fovii qspeciio�n purposes. / r
Signature (Owner/Agent) Y,� Date�''�'` 3
BUILDING PERMIT PERMIT.#„��
DATE VALUATION 4 ^ LOT TRACT "
JOB SITE
ADDRESS Sk`
APN _
OWNER
CONTRACTOR / DESIGNER / EN (NEER
`igL'!')' ;„;;,2' 0Iz CRA, 2951
`
USE OF PERMIT
CJ i., .Fb d`41J a"� dA, r:$#.,vf.�IC(Y4:✓I/jlT.Ch\CL'.�»J al'A:tld:.L� !!C. J.d�S .t`,•:..d9.1rL'• Y�yK,t i.?Gt AQJ
nlipi�.� '}'I f2, S2E<; l t `t'kt7AT, },,l�U}'1J}.L YT i$4�i lC►3iSa 140T NX k..t'BI?ED .
PCIOL-ANUZA PA III
M1.:M11M� , C06711't.i2F
CON'1'R.4, CTION IMF 101 -000 -IM -k-0001 -k-0001 .00
W1EC8J N1C,A '�fEE -. PO& 161-100-121;,000 V4:00
A,1'eT1R1: A)"K11111 •- Pt 40 10 1 -MO-420-OW) s.00
!,(.X000,, 41 1.,000 $21.0
til qa"x�JTt�L.t: fit,' 1itat, �r 1sAND :111TIAN :EM -1':.a.1
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It.�
JUN 0 6 2003
CITY OF I q QUINTA
FINANCE DEPT.
RECEIPT
UAI E /
BY r
D E
ALE
IN
CTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans E Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
-Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ShowerPans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping `
Gas Test
Appliances
Final .
Final _.
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
MR.AND MRS JIM N-TJGK-LES --
80-920 HERMITAGE
La Quinta CA 92253 RYDER COLL.
GENERAL SPECIFICATIONS
DIMENSIONS: POOL SPA
Length: 24'0" 7'0"
Width: 12'0" 7'0"
Surface Area: 255'$F 38 SF
Perimeter: 74 FT 23 FT
Depth: 3'T to 5'0" . 42" MAX
Uemo•
Concrete: N/A
Sod / Gravel: REMOVE SOD PER DESIGN
P_lumbine:
Extra Spa io Equipment: 40'
Raised Spa Bypass w/ck value: YES
Dedicated Vac Line: NO
Gas Line Extra: 70' LF
Gas Line for BBQ/Fire Pit: 12'
Spa Jets: FIVE BACK JETS
Deckin :
Color w/salt finish: 770 SF DECKING, CAP (c7, RAISED SPA
Cantilever Edge: 97 LF
3" Deck Drains (per LF): 30'
Step Riser (per LF): +6" CURB - 20 LF
Dam Wall: +18"
Raised Bond Beam: . 20 LF @ +1211, TILE FACE
Umbrella Sleeve: N/A
t Tile/Stone-
Basic Tile Group: 97 LF GROUP l OR 2 TILE
Quartzite 6" Waterline: N/A
Step Trim: N/A
Tile Raised Areas: 6 SF @ DAM WALL, 4 FT TILE SPILLWAY
Masonry'
Spillway: 4 FT GROUP 1 OR 2 TIL?:
Waterfall: N/A
BBQ: STUB OUT ONLY
Firepit; N/A
Boulders: N/A
Access Wall: REMOVE AND REPLACE
Equipment Wall: (1) ONE @ 4'H X 4'W
Paint/Stucco/Plaster: STUCCO @ RAISED SPE► EXT & RBB BACKSIDE
Pool Punish:
White Pool Plaster: N/A
Pebble Pool: PEBBLE FINISH PLAST::R
Equipment:
Pump: HAYWARD NORTHSTAR 1.5 HI' CIRC/SPA
Pump: N/A
Filter: HAYWARD 300 SF CARTRIDGE -TYPE
Heater. 14AYWARD 250k BTU LO-NOX
Controller: STANDARD TIME CLOCK
Hayward Navigator: N/A
Pool Light: ONE 400 -WATT
Spa Light: ONE 100 -WATT
Purification System: N/A
Water Feature: N/A
Landscape: SEE SEPARATE COSTING AND PLAN
Patio Cover: NIA
Fencing: N/A
MISC. SPECIFICATIONS: ALARMS & SPRING 3 PER CITY CODE
Buyer is aware that oral representation or expression ley either party is not binding
unless detailed and signed by buyer and seller.
ST 39dd JN3 Sd3GNnvs
<.- , G(a) 6""
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P/L
1 0
existing waU exist;,
bObCq,t access
.z
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GATE
760-778-2700 760-320-3667
L996 -0Z6 -09L 6b:0t 600Z/ZZ/50
:w planting area
Ise
5
10'4
new planting area
the spillway
11'11
p�ol
- 3`
24'2 ........
A
decking
decko drain -----
17'0
existing patio to remain
concrete! pour deck with V
raise for future tile finish
in patio area
light switch
NUCKLES RESIDENCE:
80-920 HERMITAGE DR.
LA QUINTA, CA, 922F13
APPROVED BY CONSTRUCTION SUPERINI'ENDANT
DATE
APPROVED BY DESIGNER & SALES PERSON
DATE
APPROVED BY CUSTOMER
24'9
$o�
•18"
_.... ...... 1711
OW
C Zlflf- P/L
° stub
existing srainage
existing wall
1
6/E
H
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P
DATE
lC - 2295 East Tamarisk Road Palm Springs, CA 92262 License No. 779165
9Z 30Vd 9N3 Sd3QNnvs L99E-0ZE-09L 617:0Z E00Z/ZZ/S0