0207-031 (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. "I
License # Lic. C_lasss._� f" Exp. Date
t7?CQ CS '�E ` �. -•
-04A..707
Date r Signature of Contractor
d_ !!
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.
/ ( ) 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 SIAM IrLIND Policy No. V0-22900
(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.agreeX6f rf I should become
subject to.the workers'' compensation,proyisio of�Sectlon'3700"ofthe`Labor
Code, I shall forthwith comply witth.tl os provisions
Date: Applicant
6 '
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 ands tate that th +above information is
correct. I agree to comply with all City, and-State-laws_relating to the building
construction, and herebyauthoQe r, resentatives f thi
p f-th 5 Gjty to enter upon
the above mentioned prope,rjin/spectijornpq'po e ^e� �,+'
�•Y'
Signature (Owner/Agent) w.•-..... o= ✓ d Date
BUILDING PERMIT PERMIT�#fl� ;y,•";f} V
+
DATE \ VALUATION LOT +SACT ', '-'p.? ;�j-.JOB
SITE
ADDRESS a 's i? aFi fjWA.
APN w
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
U'W CvI ;�C CI
t"' I. }Ntrf1�3F�,POC3 ; It d',
54-835 AWWWA-10+ RMA.
70-180703NM !€O AD #3
I.l41:}U1"NITA CA 92253
macr.70 I9II3ta-F Cly S/zrio
(7C,0)831-0660 rMILD 5735
i
USE OF PERMIT
P'00L MJYOR i '.?'d.
OL�t•yiSPA,1Say.I4AzaI'99.�flf�eilEfft wKALL: BE [N ..PLACE PIZ1 ' TO
�,9PB.il�Yd�2pIERS
fP�IOyy
S'bc�.i+'F.trita�dlGi7. ��"1�8�r `i LAV�O - .
zSTAU112D COST Ole CO.NS1*R'GfC". olf
PLAY C.CK -PRE J 01-C'00 -139-314 €105130
1CC)tdS1'rd,UCT1014VOKE 101-00.14 113-000 $162.00
Mr-WIMINICAL 'IFTE — P009. 101.000.421-000 $24,00
CUrrmc.41a - vrm .. POOL 101-000-4,20-000
P'�CS I I�i�fff IlS I -• 1' iA 101-000-419-00(l
`
x(;��� -
City of LAQUIN��
PItipm DEPT -.
ko7..dYa"li.l.t a"it•.a �rLNSdd:-Ut..�.�'J.MAiVL1LAfX 0..aVZA.+)` -
W
'RECEIPT
DATE
BY
JE TLED
INS;& ,�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE 7TINSPECTOR
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 Plbg. Test
Final
Gas Piping
41
PLUMBING APPROVALS
Gas Test
Electric Final
Waske 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
p2_
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
S,�b Panels
Exterior Receptacles
G.F.I.
Sm&e Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
t 10 eR Alo�
'5P4 %o gum b r /J3
b. -Zre 73 - .
1 • L,v u.a
� f�Isti.
1qCAL -NEVADA
POOLS
MARK TOW
70180 THUNDER ROAD
RANCHO MIRAGE, CA 92270
PH 8310960
LIC. M 777601
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE %&y0 B
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND 10B CARD ARE NOT ON
THE SITE FOR A SCHEDULED
WSPECTION.
•
'L
VICINITY MAP
;.. ; 00 V
u t]lt;tr I Iumm
OWNER to fence pool area and install self closing and self latching gates per code.
N6TE: No dirt will be removed, returned or graded after day of excavation.
Designed by NOTE: Relocation of equipment pad will result in additional cost to owner.
KERRY R. K O E H N L E I N IUE:a-z
NOTE: Fill pool immediately after plaster (follow instructions). Do not use rubber hose.
moo✓ NOTE: Do not tum on pool light when pool is empty.
PHONE 360-0012 NOTE: Wet down concrete shell at least twice daily for seven days after shell is installed.
I have reviewed this plan and hereby total plan & speciecations.
DATE CUSTOMER SIGNATM
r
POOL SIZE x 2 16 .Depth _ x 4 X.
SurfaceArea_ �), U 0 Perimeter: `(;i', --
EXCAVATION Access Grading (. �&
Dig From 5h -W 0'c•a Obstacles
Walls Removed V t.S 6/0 Replaced V C•5 l -"
Misc.
PLUMBING Filter' ::I A4, • C,&,2
Size 300
Pump J act: 'Sae 7,
Booster Pump 6%
Skim Run 3 J :. Main Drainer
Ret 3
FII Line /Ly?y Purifier
Auto Cleaner P o L; A 443
HrTye1"pGas
LIF p I
FOUNTAINS=SPRAY HDS—WATER EFFECTS
Type
Size
Plumbing Length '
Valves
Booster Yes/No Type
Size
Misc.
STEEL GUNITE Eng
Sur -charge
6' RBB 12' 18- 5 P A 24 --
Step Risers.,_
Spa Wall Width_
denches
Love Seats
Spa Dam Wall "Irl L
Notch '2
Misc.
ELECTRIC Total Run L/F 3 A
Fiber -Optic N D
Remote AY t)
Spa -
Misc. 5 lar• j-%
TILE W/uneiP. S -- -
Coping
Step & Bench Tile!
_
Misc.—Glass—Etc.
DECKING Sq Ft L4 Type Ste'—T'_ Color4P
Nat Concrete Sq Ft Cantilever
errr-
D.O.D.L/F Step Risers
Misc.
SPA Size 'I— Area 3 % Per2 _
Pump S "' Blower (— Spilhvay_ 1,L,-
Jets Co Step —# Light -LO -6 ki
Misc. iQ,rrgPd !U"
INTERIOR FINISH M Color
Other
OWNER i�LJI 5 JtwA.A,F{t
ADDRESS 5f-935 &.0.4 fteQet'ed-4
CITY -LQ—. --SOLD BY DATE `7�7' -0 1'
PHONE (H) ?. (W)
DRAWN BY DATE