0307-363 (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.
License # Lic. Class Exp. Date
9165 A 111 RIC 5/31/04
Signature of Contractor
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.
(1) 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 STATE INNI"i Policy No. It 6W 611-M
(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,shall fort with comply with those,,p ovls&ons.%
Date: n`" 7 -.�� Applicant�'Pi`:');' Ja'`'s"
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 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' b1
PERMIT Ji
BUILDING PERMIT
DATE VALUATION �4 LOT TRACT
JOB ADDRESS 4 -Z:Is�1'�Y�,�t CORONADO
APN
3:
OWNER CONTRACTOR/DESIGNER/EN &NEER
z"._ AaE3.`OR, Wa—AYALA +C'AtfYON VW9 P-:)01
44.319: VIA, .:0k01�'� )0 * . .
'L.44 Quavik CIA. 11`�i,1253 P.K,?.n 21PIWITC1`5 CA, 922,i;a;
USE OF PERMIT
:E'C1UE.,,tili'D11 lZ. SPA
�bidl'.k���'�`t�.�N: �:i�U(t���;?�'f fs7�i'�"•L4��iii?fv Pi0`,f` lAiC').ti�.i's:0
x'(JOL AN.l" OR SFA
1fi,111041t0 L2
XT).' 11I'AMM) COW OF CIf;3AN LIMC.'•?:7D13 16,Uwmp
'.ii,'((.�7Aq��t�3(�it31VAU111 sr"A"WAR'!t p�A 7 7 VILA'S ft g
Ss T�� `t',faii F;tk l02 000-4$18-iM'0 ti ±9.C-0
FI,IYC.T IC.Ai:.:fFi1— POOL 1014 c 0-420-1100
PLkSM INO RINE __ P0.01. - 101 _(K)0_4I9_000
SUB -TOTAL C011�S'1'UC;'F10INT1`,,IMPi.t'.l`3'CIRE-11C 8.1.5
[wXS_DT.PK d, .0 &0 d4 .15
AUG 14 1003
CITY OF LA C UINTA
RaCELPT FINANC, R,T 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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings •
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vobge Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
� 4-4-385 VIA CORONADO
. LA QLT\rrA CA 92253 ".' : /L
GER'ERAL. SFIIX CA QNS
DQENSIOlvS• POOL SPA
t-engffi. 28'0" 7'G" LANDSCAPE RD�ORhFIUl1011LY
Width:l2YP7 Cr
Surfau Area_ 388 Sr 49 SF
• Perimteti : 95 FT 28 FT Ei0STU1G REiAFt]IG WALL �
Depth: 3'x 5'x 3' 42' MAX
Demo;
Cancnete: NIA i
$odlGravelc NiA ` '
Fatr& 4h to Egnipnww,: - 60 LF
aised Spe Bypass kk value: YES SET B •la'
R�c
Dtdiraled Ya Line: YES ^ 85tt Yt0 Dcr TIOtn -
1Gh9`1 in:Fxw: QUA a 6Y ow?gm)
-7 Gas Line for BBQTirePit NIA. P
w Spa jets: FIVE JETS(Wjdm M atiraa) V I - +6' Ralsai bond 'eam
�r5'
nacenitench 7'O_ Cofinslh 481 SP D) dING, CAP (d RAISED SP � c� -30 1CaN.dum Edge: 96 L.Fw �^-•�� (A71'Nq 3"Da%Drelr6(perLF):.NrA\00.Step Riser (Per LFx 7IF OF 6" RISERSDartWall:. +18" —, s4.. 4'
ol
rib 3r6n
Q Raised Boni Beam: W@ REAR OFP400L
UmbwJla SW%w ONT @ TANNING LEDGE
YileSiamc - - I I 3s P/L
Basic Tile G7aup: 95 LF E' GROUP I OR 2 TILE
Quutdw 6° Waterlbe: WA " _A
Step Trim: MIA decking 5 � I
Tile Raised Areas: 10 SF @ DAJA WALL & RBB GROUP I OR 2 TILE- I a vm6rc�la SCve
o _ _ 66'17 - tamng Ledge
Sp TWO 4FTSTACKED QUARTIITE - 12% 9'5
VataWL NIA // EXISTING CONCRETE PATIO �
BBQ: NrA
F segil: WA DO NOT DEMO
Bauldem. WA /
Aooe_lswall: ):rA �e---
LD Bgaipmeot Wall:. IOLF.. POOL 6655 mPlaee each
L.0 Pa6l"Stucom'Plasra STUCCO @ RAISED SPA EXTERIOR O— sleeve all 0lante-z Mwking day
U) PoolFinisb- LKD5PoolPbater: NA I AYALA.RESIDENCE�5bob�fltaecessCV PebblePoaL WA HAYWARDNaiuw TAR1-5HPCMCWA � "7385VIACORONADO.Filrtr: MI-AFARD 3W SFCARTR@06TYPEA. I '
Heap: HAYWARD 250L BTU LO-NOX LA QUINTA CA,92253
Cowir3ler. HAY_W-ARDPOOL BOSS
Ha4ward )2awgatoc NIA
Pel usbt ONE 400-WAT F '
SpaLaght: ONE L00 -WATT
. AQUA -RITE SALTSYSTEM
Praifirdtioo System:
m _ Landscabe: WA .. .. - _ - - -
Patio Cour" NfA
Pencfna: - Replace ucesfaiceea:bwv-4wgday.
C7 MLSC SPECIK[CAYJON_S:_ ALAR).LS & SPRINGS PER QTY CODS
.m Bsryrff is mere that mel represeatetian ca eepeasloo by eilhv paM, is wed tdodPoB - -
CD ao3ess4etatied "d signed by b yerrodseua. 760_77A-2700 760-320-3667 FAX 2295 East Tamarisk Road' Palm Springs, CA 92262 License No. 779165
0
m
CD