9808-058 (RPL)J LICENSED CONTRACTOR DECLARATION -
tn t l hereby affirm under penalty of perjury that I am licensed under provisions of
1-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Code, and my License is in full force and effect.
5 ch License # Lic. Class Exp. Date
til 8�2 f 4 ' ri t 931199
ti Z
o Z Date Signature of Contractor;
co O rl� f;f;f i
r` I— � OWNER -BUILDER DECLARATION
W a I hereby affirm under penalty of perjury'that I am exempt from the Contractor's
License Law for the following reason: (,i
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 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
O N Date Signature of Owner
0- Q WORKER'S COMPENSATION DECLARATION
C) (r I hereby affirm under penalty of perjury one of the following declarations:
Lo Fa- O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
Q 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is issued. My workers' compensation insurance'carrier & policy no. are:
Carrier Policy No.
Cb d CLAM. 'LION IS. 01KRCi000891
J
(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, andagree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Cede, I shall forthwith comply withtFi'os provisions.
ate: Applieant��'�'
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
4 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 harmles! `th0City of La Quinta, its officers,'agents and employees.
2. Any permit issued`as a result of this application becomes null and void if
work isnot commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
a b I certify that I have read this application and state that the above information is
' :."�•g correct. I agree to comply with all City, and State laws relating to the building
m construction, and hereby.. authorize representatives of this City to enter upon
the above -mentioned -property for inspection purposes.
Signature (Owter/Agee Date /�_
PERMIT# F CONTROL#
BUILDING PERMIT
t j 9R111i-i���i aaa���
Q
DATE tj " VALUATION $licd fl -� LOT TRACT 73
JOB SITE
ADDRESS 54-905 AVE N10A HERRERA
FAPN - .(
OWNER CONTRACTOR/DESIGNER/ENGINEER
JOE SM PR?;D0 BLUE, HAVEN P0_ OLS
,34905./AVIrNI.:DA.11FI ERA '231S S. -VINEYARD AVENUE
' 'LA. QIAT t A. CA 92253 ONTARIO RIO CA 91701
(909)947-6174 GFt1, S2�1t)
USE OF PERMIT
k'(JOL.FiNDiOk 9PA
POOL AND SPA ONLY, AL AR1vIR AND OR BARRIER ARE fi:GCaUHIED F' WR ,. LJ
AUG 1 2 1998
1t�X0tSTl ,I`I� OF'
�POOL
��N��
EISTMM-T—L 11) COST OF 1111ONSTRUCTION
PIAN C'1WXJZ,. FEE 1 d E -000-439-3111
CONRTRUC' Y• NFFR 101 -t1101 -OW -118-00-0-1 M90)18-00-0 90)
IVILCRANICAL � Cr, -- POOL
.
_101-000-421-000$7A.00
IRECMfCAL'ME --POOL 1.0.1-000-420-000 $45.00
PLUA111114INO• FEE -- Pool, 101-000-49-000 $27.(10
S TSS -TO A1, CONS'i`Rt ICTION t1SND PI AN e;I.1FCY
$447,95
LESS PRE -PAID FEES
40.00
0-1-A 1.,1 EIRI 111' 1{ BOWS OUE NOW
$4017.85
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
4
b
INSPECTION RECORD
i 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 Plbg. Test
Final
PLUMBING APPROVALS
Gas Piping
Gas Test
Electric Final
/�
d
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
l
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
Wility Notice (Perm)
COMMENTS: Q
�jQ/i9 fsl.9 r!r!Ld— i G�
•
1
s
r
1'
�
PAR'I'S LISP:
M(YI`OR - HEATER
20 AMP 2 -THROW BREAKER
1/2" CONDUIT (ADD -'W12 GROUND WIRE IF •P.V.C.)
2- H 12 BLACK AND 1- # 12 WHITE WIRE,
220 V WATERPROOF TIME CLOCK
1/2" WATERPROOF FLEX. CONDUIT WTTfI CONNECTORS
LK3I i•T
15 AMP BREAKER
1- #14 RED AND #14 WHITE WIRE
G.F.I. AND WATERPROOF "J"BOX (ADD N 12 GROUND WIRE)
SWITCH AND WATERPROOF "J"BOX
BRASS "J" BOX
Time Clock
Heater G.P.I.
Switch
Brassll HoCor
.J
Light t `(z" 4As L I Nfi
A
C
Panel
CA-*
51
IVER ROCK CASCADE FROWSPILL
7' DIA. SPA W/ LITE &SPA, RAISED 18'—'
4'X12" R B :B
ATO B & B TO )AA VX 6"RBB ATA
RIVAR AL-- 51 PIPN(-r
A
SIME P/L 5'FENCE
AC ESS
ELECT.
SKIMM
A/C
PRADO
RESIDENCE
SEE ATTACHED SHEET
FOR ELECT. HOOK UP
SCALE 1/8"= 1'
3
1' R p
TY ER FA -L
Ty
20'
POOL-' 7
16' II
5'
73 Sltft-
THOMAS GUIDE
MP 879-F3
C/S CALLE TEMECULA
41
-..- .-- I
516A F/L
Pool fkmoefs
Since 1954 (909) 947-6474
(800) 479-5564
Fax (90.9) 947-4393
E
PGM2318 S. Virievard Ave.. Ste. A
Ljr- No. 618892 -C -S3 Ontario. Calnorma 91761
Lv
Frm
BUILDINIC.37A & ENT
CONDITIONALLY
ACCEPTED FOR CON' Sll,°RUCIIQN
SUBJECT TO INSS'Ia'LLATION AS PER
M11
AND ALL APPLICABLE CODES
By
I
G= -NEPA'- *=. SPS-=IFM�-' ONS
-1
. o Ari EA SCUARS FO ;7
EXCAVATION
ACCo= Raw
Sao Cal Shuns 01C
pkegra" on —
Aa move Stumalsi
AWvcm4o Force
Rectace Force
S.
C*vm?a
STEEL
Exmu" W Stem P.Sto I
PLUMBING
F0w ftin - '
F—v
Asumn Urm
Tyos rjnfdCRPTF'r
BacKwun Lx* _0 Trw
Gas Urn__FC
ELECTRICAL
Run By -__QFq.
_7
3UNITE
L04, Saw
SWAM OtA
Ext, 2nd Stoo
Abb
I% X FL
Rbb —
In. x Ft.
COPING
PW" 9 ho
Type
is
Smar-Sox
TILE
04
type
Yes
So& cam
Sonat ugm
A=mtt Tie
DECKING
Tyos rjnfdCRPTF'r
C=r
i =anston
Fomngs
btasac
Draw
EQUIPMENT
.Fimr Type CAJZr Welfa
PW" 9 ho
(2't.-
is
Smar-Sox
Yes
04
AcuaMagtc
Yes
Sonat ugm
Yes
5W W Ugrit
(Lits.
N
smarvvar.
Y as
(E
E.--ergY Vac
Yes
(E
Hamer 4= STU
Na:
F.
Board
Slide
Shemer Descent
stze
PLASTER
C,vor-PERRI-F- TELH
SPA
Size -7 A In C
MUMCifV PAO
Dam wag uwxm
Numoor of im 4
BkY*,W —H -P- Yes
perms—Mod slo -
so& side swrvl Yes
s'nar'L-grd 01
too wan Ught Yes
BUYER
IrAus
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oadung srcwn is nr ZuS7--5Cn Pul-c-l" 3fly
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tears feet Ct ceoc
Prepared Especially For:
MARY FE -Q
PM05 AWE 141 DA H F-RRER&--
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