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9709-014 (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: Licensei#1� a ±`ic. Class a Exp. Date�j7g pp :.Date j ` �'' 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). O 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. Myworkers" compensation insurance carrier & policy no. are: Carrier s-IIN "1= €7L 40 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 Obfect`to the workers' compensation provisions of Section 3700 of the Labor JCode, I with comply with'tho halLfortbse provisions. Date: " <�' Applicant IV -6n..>' �:lita 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 applicationbecomes null and vA,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. ..1 certify that I have read this application and state,fhat the above information is,. correct`..I agree to comply with all City, and State; laws relating to the building co1r struction, and hereby authorize representatives of this City to enter upon +�t e above-mentioned property for inspection purposes. ' t O /A ent),�,r.;.;'jj� Date `Yr. BUILDING .PERMIT PERM�t'"Y�9«��A CONT5855 r,.—`iJ.4YiD VALUATION �' �, LOT .. "' TRACT (JJ JOB SITE fa_• 5i°�."1 ti t^4 l .B rEM.9�: 44:-.ia APN t► 6.Fy 3.13SK�lNga;6 ADDRESS OWNER CONTRA�'tC�TOR / DESIGNER / ENGINEER g ( 6.r��1.�-1�:A ;i✓�. i�.'�.�:�. Y.ONNIRAN%! CON p �p 1, A.r�ir� L,.��." I)S i; au OCiKa c�. ,1.f34U t'r' :iiis . .I t3 I L SIT,. I .4�4 a;~ ry � t�0270 • w,.1�5NTA VIVA;. f .lr'.f �.' 02ltl,rl T`i-�iq?i {1� ryzA T,' �Ty�all.�.I..yI �1.ERb,;R, .� ew'-A, ��r2,60 €7fsC))4'� — 40-32 CI C tf 1044 USE OF PERMIT kfYtA, .rtisrwr..ats.cawiii..VivyYty .- . Oft P � } ♦ 1 a dv�•�a� a (pw�1 g y�yw,t °9;e'��p•:iYi�i\rbv.rd`�e.~,i��Y >-9..X.I'tV t.Y?.Fi4.i`i:.73.N,f1`b NIA . . � .a iy4a�.fib25. �a�Fa',,vt1+��ilets2 8'yAf�? fst���fz.i':�i, f (?�:.:�1f�C�.•r4,.ta»;�'?d' �y�;l�jij 4� 7 r t -• SC?L;• . l,0,i t;�ft 10 o X410 Pt,.tIMAIWW -IX P06t 0 rc�E Oi 4194X) # t ` Al `: A, i t %`r€�I 1`NO > l�.%ra ,_.,.'y# j�++�j 1' l,e ls. ''S 1111;r Y ilktD 4llf '�;i � j~.. WIT"' .11), V, ��ti;/,6/1J - •j Vii• �.I' ' FIO S 0Vr ,NOW 'SEP 0:9;.1997 �� E�E e )U iQBTA FftCEIPT DATE' • - B11 DATE FINALED - INSPECTOR . - - Igna ure ( caner g - INSPECTION RECORD OPERATION 177�DATE I 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 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 Shower Pans 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: CONTRACTOR cannot assume responsibility for GENERAL SPECIFICATIONS damage to curbs, sidewalks, driveways, cement SIZE 14 X 28. R16'-3 slabs, sewers, lawhs,trees, fences, retaininq s PLwalls, sprinklers, telephone lines or shrubs. AREA 346 PERIMETER 74 When access is made through a neighbor's DEPTH 3-5 \� property it is understood that you, the owner. TILE CHOICE .GROUP 3 S , ' +9' PL } have that neighbor's permission and assume full. ` RBB: +6"/SPA PL \�• responsibility. COPING CANT DATE sii4nature POOL CAPACITY GAL \� PUMP CAPACITY GPM +1 3' SPA + 6" MOTOR HP STARITE Hp1.51 R6'-6 --18'611 y — r 10`� R5'- 0" r R3'-0" 15' \ (= ----- 7-"' --28'661 — --- 9' I 12' -4 PL + I. +4' I PA MOTOR HP AHP FILTER STARITE 300 SQ FT FILTER RATE GPM HEATER. LAARS SIZE 400 BTU TURNOVER HRS SUCTION LINES 2-1.5 RETURN LINES 2 SKIMMER MODEL " CHECK V GASLINE BY S.D.C. FT. POOL LIGHT 400. CLOCK 220' ELECTRICAL BY. S.D.C., AUTO CLEANER CHEM. FEEDER PLASTER COLOR WHITE DECK BY OTHERS, SQ. STEP FT. SPA SPECS. X Al Ll \ i SIZE 6 RAISED +6" 16' 1918" - LITE 1 WATTS 100 r _ _ vI RI LEVEL SEATS 22' 24 27" \ i DAMWALL 6 11 X 6 F \ I DESIGNER DAMWALL TOP TILE \ SPILLWAY SIZE 3 " X 1 8 "WIDE JAMIE SPILLWAY X OPEN CLOSED DATE # JETS 5 UPER LOWER 8-20-97 Name: CANADAY & CANADAY Address: 78=885 VIA FLLORENCE - My- LQ TRACTLAKE LA QUINTA LOT# LOT 103 'Bodsoffs PCV141 PALM DESERT TEMECULA C©p737011 COUNTRY 28910 RANCHO t CLUB DR. ST F-4 CALIFORNIA RD. ' STE 206 PALM DESERT CA. TEMECULA CA. NOTE: LANDSCAPE AND FURNITURE 92260 92590 ARE SHOWN FOR ILLUSTRATION (619) 346-4032 (909)676 -SWIM • ONLY AND ARE NOT INCLUDED. IC 0 A-5741 77