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0007-046 (RPL)LICENSED CONTRACTOR DECLARATION .-I-hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (;ommencsng with Section 7000) of Division 3 of the Business and Professioivals Code, and my License is in full force and effect. License # Lia Class Exp. Date .•-�3r51673 C53 },fii Date;! Signature of Contractors 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: O 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 perfo ,mance of the work for which this permit is issued. +i9 -1 -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: CarrierSTATE F'-UND Policy No 2%q-0f1•fJ0i93`.s� (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 forthwith comply with those provisions. " DateApplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety - for a permit subject to the conditions and restrictions set forth on his application. ' VEach person upon whose behalf this application is made & each person at' Whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result.of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply .with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for. inspection purposes. � Signature (Owner/Agent) Date���'� •�/�J� BUILDING PERMIT PERMIT# DATE VALUATION LOT 0W7"046 TRACT �:i.��1tIfD.O(I JOB SITE '' APN ADDRESS y d.Al.'fuOd�d`aL� ,`e1 W-91.15 _ M OWNER CONTRACTOR/DESIGNER/EN INEER CAKIWAY & Ct3w"Y HAL HAWTON dbc V ACKTION POOL$ 1°7480E_1"Iffl8T, #106 , Y. 9522. DONALD 014 RD. T'(lerM CA 92'780 , WCERNEVALLEY CA 92356 (909)248.6045 CBIS# 4335 USEOF PERMIT - POOL AND/OR OPA POOL &SP ONLY . ALAItWHARRIJM3 SI'.AL.L 811f IN 'PL&CEA'PTHE PR&PI.bAS1TER INSPECTION. THIS PERMIT DOES 0 O I'K'C:C;UD9 BLOCK � WALLS FOR EQUIPMENT I13CLOSUIZE. r' VALUATION JESIU"TED COST a' C0tvS'cxrCr10.� PKRMUFKC 9UMA"RY PLAN CHECK IEE 1.01 -WO -439-31 8 SIn3.30 CONSTRUCTION FEE 101-000-418-000 $J62.00'* MECHANICAL IEE -- POOL 101-000-421.000 $24,00 ' XLFC;TRICAL FZZ — POCI, 101-000-420-000 45.00 P'' Upa4BlNG FEE - POOL, 101.000-419.000 $27.00 SUB-110TAL C01rA'RT CM01.3' AITD PLAN $363.30 LESS PRE -PAID F ` ti $0.00 T(i':I'LA_e PERMT F + R_ DUE 19OW .a . RECEIPT DATE &Y j DATE NALE) INSPECTOR INSPECTION RECORD J* OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS S, -,t Backs Underground Ducts Forms & Footings Ducts .Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 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 e 14 Equipment Location - (O Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final e 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 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) Final— COMMENTS: Z-0-+ o3 9522 Donaldson Road 4_,4 Lucerne Valley, CA 92356 G +-'k (760) 248-6045 (760) 248-2919 FAX Lic. #C-53-351673 Sales Locations Bermuda Dunes, Irvine, California City, Rialto, Lucerne Valley 1 800 999-1811 ' PL G P CIFICATION SIZE X lo�� AREA PERIMETER Sloe �t Y DEPTH TILE CHOICE SQ. RBB. Pe� vp\_ l r COPING W (`� POOL CAPACITY GALS W r PUMP CAPACITY GPM :•�©� MOTOR HP HP • . MOTOR HP HP :• • : , .� • i�.. �f.'.. ••.::':�` FILTER SQ FT •:.'. ~ �'' - ,:.. /,% /t� FILTER RATE GPM .i. ..•• 3 v :'; ►.':'.:... ..• .. lr`� /`� I HEATER. SIZE BTU POOL TURNOVER HRS • • i ,r ::::: •: : , : ; } "p SUCTION LINES - -- J i.::. '... .:'� RETURN LINES :�•.:; DE •.' r-, • : • .. • SKIMMER MODEL • , .... ' ''"•� ' -• CHECK VALVE BY FT NE ♦ • .. • ,� .� ,, ,. .• • ... .• „ .►. 'e•' �, •• . , • '..• .. � .. POOLI t••LIGHT CLOCK r • : • ..� ; '; ., s ELECTRICAL BY FT. • • ti : �: AUTO CLEANER CHEM. FEEDER . ' PLASTER COLOR DECK BY t•• ► CITY OF LA Q INTA A RE -INSPECTION FEE PRO EQ - DECK TYPE SQ. • x, BUILDING SAFE DEPT. WILL BE CHARGED IF THE AP STEP FT. QLANS AND 10B CARD ARE NOT 04 s, APP110V D SP1A Sl -'E(, D /ewC� 3 THE SITE .FOR A SCHEDULED SIZE RAISED • I` e S' a FOR CO STRUC ION INSPECTION. ;; .NO EXCEPtIONS! LITE WATTS // II DUAL LEVEL SEATS DATE CJvBY DAMWALL DAMWALL TOP SPILLWAY SIZE X WIDE . CONTRACTOR cannot assume responsibility for DATE SPILLWAY damage to cubs, sidewalks, driveways, cement #JETS f slabs, sewers, lawns, trees, fences, retaining walls, sprinklers, telephone lines or shrubs. Name: When access is made through a neighbor'sroperty , 4 it understood that you, the owner, have that / / neighbor's permission and assume full responsibility. Address:/Ov Ci OW; Aj l DATE TRACT L �'� �• LOT# Io6 SIGNATURE i