9708-051 (RPL)I..ICENSED CONTRACTOR DECLARATION
I here*1 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
C'43wc`;r+ yPro.fessionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
I-- OLLJ 374127
�o Z � Date y g Signature of Contractor -
(fl 0 �.
JU OWNER -BUILDER DECLARATION
CD
LU W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ t1 License Law for the following reason:
Z ( ') I, as owner of the property, or my employees with wages as their Sole
--,% I
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.
I;have and will maintain workers' compensation insurance, as required by
Ion 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.
r.t � Fps L,.9r43�:).s r,`�:�f �.r. !i -•e? _'
(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'Labor7
7.
Code, all forthwith comply th those revisions.
Date: Applican
s
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 histD
application.
1. Each person upon whose behalf this application is made & each person at"'s
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 voidJf
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 rnspection purposes.
Signature (Owner/Agent) of Date
BUILDING PERMIT. PERMIT# CONTROL#
G `.
57-18
,
DATE VALUATION _ a^�;LOT' _ •• TRACTJOB
SITE
ADORES S , .. 79-97-8 IVIA . LGItEi� CEI
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
hf; ak.€: OLL 0, W f�t'�..F 20;K - -
i3.6t1 I �,i�UN"RY C;IX8 Dk1V1i?, ,-M,'. -4
.. St1,NTA.AN.A. CA. 92105
3t��sG1.(fl,N4 DE8€:RT CA 160
t9Y�,
qd
USE OF PERMIT
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:.AUG 14' 1997
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`RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
A 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
POOLS - SPAS
Steel±
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
f64 01
Gas Piping vr
PLUMBING APPROVALS
oe
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:
��%G�"✓/��'` ,��//
30'.
A
CONTRACTOR cannot assume responsibility for GENERAL SPECIFICATIONS
SCOTT SPRAY HEADS ARE 'OPTIONAL PLEASE CONFIRM damage to curbs, sidewalks, driveways, cement
slabs, sewers, lawns.tre4s. fences, retaining SIZE 13 X 28
5'-3" walls, sprinklers, telephone lines or shrubs. AREA 288 PERIMETER 83
'
When access is made thro ugh a neighbor's DEPTH 3-5
F"' 211 property it is understood that you, the owner,
TILE CHOICE T.B.S SQ.
have that neighbor's permission and assume full
RBB. +6"/SPA
responsibility.
COPING CANT
R31-011 DATE si.9nature POOL CAPACITY GALS
7- R2, PUMP CAPACITY 100 GPM
MOTOR HP STARITE HP 1.5
R2'- PI MOTOR HP HP
FILTER STARITE 300
SQ FT
+5 f 316@1 vIlly
FILTER RATE GPM
+6, HEATER LAARS SIZE 400 BTU
TURNOVER HRS
............
+20 SUCTION LINES 2 1-5
9'-9°91-31f, 1-91 PI RETURN LINES 2
12
4 SKIMMER MODEL
....
- ---------------------------- --- . ..... 2.8 - --------------- .. .. ..............._._._...---------1-- -..
CH cK VALVE YES
GASLINE BY S-D.r. Fr. 50
POOL LIGHT 400 CLOCK220
-R2' f 2 -lay out line ELECTRICAL BY. S.D.C. Fr. 150
R2' AUTO CLEANER
5 CHEM. FEEDER
PLASTER COLOR WHITE
DECK BY SQ.
DECK COLOR
18!-8" ETi:1 STEP
FT.
5'-+ 51 SPA SPECS.
�{': O SIZE 6 RAISED +6"
jo LITE WATTS
TRI LEVEL SEATS 22" 24-1 27"
It DESIGNER DAMWALL.TOP TILE
DAMWALL 6 11 X 7 Fr.
JAMIE SPILLWAY SIZE 3 HX 18 "WIDE
CiI Y OF LAQDATE SPILLWAY x OPEN CLOSED
UITA NIvA 7-17-97 # JETS 4 UPER LOWER
AF
BUILDING & SEr-e-DEPARTMENT Name: CANADAY&CANADAY
CONDITIO&
ALLY Address: 78-975 VIA FLORENCE
ACCEPTED FOR %C,0N*STRUCT1O1?4. � LQ
SUBJECT TO INSTALLATION AS PER TRACT LK/LQ LOT* 112
ND ALL APPLICABLE DES
BY POO/S
PALM DESERT TEMECULA
j', jE11 Copy
73-011 COUNTRY. 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT STE 206
TEMECULA CA.
LAND CAPE AND FURNITURE CA. 92260
92590
ARES OWN FOR ILLUSTRATION (619) 346-4032 (909)676 -SWIM
TONLY AND ARE NOT INCLUDED: LIC # A-574127