9708-058 (RPL)LICENSED CONTRACTOR DECLARATION
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
►r� .,tJ !1., 81.1 ZIP
12
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).
( ) I am exempt under Section , B&RC. 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.
oct= 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 Policy No.
_P't
(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 withlfhose provisions.
Date:� Applicant Z /� , 7
Warning: Failure to secure Workers' Compensati n coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706'
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. r
1. Each person upon whose behalf this application is made &., each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of,this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned properylor inspection purposes.
Signature (Owner/Agent) �" - Date -/(/- 9
f
BUILDING PERMIT PERMI A71t>$•�)§� CONTROL#
5724
DATE VALUATION . $1.7.,928.o f LOT TRACT
JOB SITE
%.�61-kihtaV.
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
J4 1 #,j {S I`fA 4' .lr{ 7'f lAri17A?rl
f R'i7P �J ti8'll f'vi { •i"1PlL"f'!5't k r i""ft
1.570 1KLtJ4H3LLOW Jiu i,kil iZ oVA
7:S11 .Ni14,1.ft CLUB 1
1AVti, ANA, CA, 02/05
C�JAF�
ErALS 9V2.C2,6�0
€7fil)1 fAfi�i� CT1114 Y144
USE OF PERMIT
POOL
POOL AN MR. SPA LS
.E1n �, A�•9yi�+i./ i..os"t Of,O,.Ti.Y:t
ERMff a,REtiaINfti 1EbRY
H.AN <.:' IrICK VRL tit')
F �F3a� f 4�I ti.-`,7'Jf?N FOlz 1(41.«000 -[?18-001 V143,011
INif'.J:slUNl�.�Afw 1']kt)—.[4.fa.7j.. V! '1:r.5iV'4si "1 _000
k Af } (•i: _.,,i'DiPI. i��-i}f31)-MGG i t)l) A�S.i)t}
€/;L.fWRANO frRE—,POOL loi"'t'afit:)„rks.�3�(?f� d�"Tait�f
V
AP- TI Shy. TIRE., -PAID FEES
10.06
AUG 14 1997 'RY U PFAMIT . RES01111,c NOW
1"33, 6 . 0
Of LA ()wNTA
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
tF=
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
0. 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
Sted6
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric A
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:
i
CONTRACTOR cannot assume responsibility for r-� p�;,-PSL i_� Fi ATIONS
dama a to curbs sidewalks driveways, cement
slabs sewers lawns trees fences retaininci SIZE 13 X 27
IIs sprinklers, telephone lines or shrubs. AREA 300 PERIMETER 76
When access is made through a neighbor's DEPTH 3-5
r.
propertyit is understood that you, the owner,TILE CHOICE, SQ.
have that nei hbor's ermission andassume full RBB +6" (SRA) /+ 1 2"
responsibility.COPING CANT
_ DATE signature POOL CAPACITY GALS
a PUMP CAPACITY 100 GPM
MOTOR HP - STARITE HP 1.5
.. MOTOR HP HP
FILTER STARITE 300 SQ FT
`s FILTER RATE GPM
HEATER LAARS SIZE 400 BTU
URNOVER HRS
SUCTION LINES 2-1.5--
RETURN LINES 2
SKIMMER MODEL
spray heads -HECKVALVE YES
GASLINE BY S.D.0 fel .-
rbb +12' `P1'�
POOL LIGHT 400 W CLOCK
\ i ELECTRICAL BY.
� J
UTO CLEANER
- Z-0.00 13'-5
HEM. FEEDER
CASTER COLOR WHITE
ECK BY OTHERSSQ• SQ.
DECK TYPE
3, �� - - ----- i TEP FT.
SPA SPECS.
7'-7 1
P11SIZE 6 RAISED +6..
LITE 1 WATTS 100
RI LEVEL SEATS 22" 24" 27"
DESIGNER DAMWALL 6 - X 6' FT.
RANDY DAMWALL TOP TILE
SPILLWAY SIZE 3 -%. 12 WIDE
DATE PILLWAY X OPEN CLOSED
7-17-97 JETS . 5 OPER LOWER
Name: CANADAY & CANADAY
Address: 78-965 VIA• FLORENCE
City: LA QUINTA
TRACT 1 k .1 q LOT* 111
A 10 �li
PACK DEGIETLE"ECULA
73-011 COUNTRY 28910 RANCHO.
CLUB DR. STE F-4 CALIFORNIA. RD.
PALM DESERT CA. STE 206
p NOTE: LANDSCAPE AND FURNITURE 92260 EMECULA CA.
92590
RESIDENCE ARE SHOWN FOR ILLUSTRATION (619) 346-4032
(909)676 -SWIM
ONLY AND ARE NOT INCLUDED. 1 1 : „ _ �-7 A ,
hkl