9010-041 (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-# +fix Vic. Class Exp. Dell%
Date "1� �%s Signature of ContracI I �Z„��:
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 ine proj5erty, aril 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 37,0l�offP%Labor Code, for the performance of the)worktS?r which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier 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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: //#"2/ 76 APPlicant�t /l �.. f~,l ��r3/JF��
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) X/a •� _.{! / ', /� Da�
t
BUILDING PERMIT PERMITk CONTRAAOL#
Vb.f1-6id.1 `# L ®' 7
DATE 0/14,- 4 VALUATION ;��dSr51l11•fYi1 LOT TRACT
JOB SITE 41-420 .,iiM00 APN ri
ADDRESS -
OWNER
C;"W"V Y Ci1.0N. .'LlI CCiMMUNI'll fig
SAN 131. RNt11tl IN- *CA 92408
(MY)_1R 1-4007
USE OF PERMIT
P,C)01. ARD SPA. OKUY
CONTRACTOR / DESIGNER / ENGINEER
68805A PFU 1W), :YE9
CE1.'(THE0101, MT CA 92234
(614j324-1232 CSTA, 1044
is%' Ia. 3iti'C.IVt' ED C:;("ST Coy CO NY FRtii:TQON
.11,10KMI1' F3;1!;Si RIMA -9V
1ll,XNC-IFid:,%,tit✓ S111.15
CONST_LJ ."110N x 18 101.000-41M0{)
ME-04ANICALFM3 7 -,- PW,11, 10140-421.000 .()0
Ef,RCI t.MPtL;FFM — MCI,1, 101.000.420-000 Sri �.�►
P1 t3MI1+i0 Ft;:.r.-- POOL. 101:-AVO.419-000 $27.00
Sl B- TC'!`l.'At, CONSTRUCTION ION AND PLAN C14ECK
ErT•.�s.• laze
OCT "2._ 1996
i
RECEIPT' I DATE
DATE FINALED JINSPECTOR
c3& 15
VMW
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 Wail Insulation
Condensate Lines
Party Wail 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 AA
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
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 (Pemv)
COMMENTS:
.:..
SPA SPECS. GENERAL SPECIFICATIONS
-71
r---- ------ ---------------------- .-.--- :----------------- 321 .......... -_........................ _.-----------...� SIZE X AREA
SIZE
RAISED 121111DEPTH 3'6"X5'X3'6--
LITE 100 WATTS SHAPE REC PERIMETER 94
TRI LEVEL SEATS TILE SIZE CHOICE GRP 3
2211-2411 2711
r 7i DAMWALL WIDTH 6" TILE COLOR O 3
a SPILLWAY SIZE
1 ,v 31h COPING
COPING COLOR COLORED
SPLLWAY
I OPEN CLOSED" POOL CAPACITY GALS
i PUMP CAPACITY'. 9.5 GPM .
#JETS 4 MOTOR HP MAXI 11 HP
FILTER MOD MEDIA 300EQ FT
FILTER RATE 105 GPM
TURNOVER HRS
SUCTION LINES
15'
,RETURN LINES _
.20'+ MAIN DRAIN "
\� SKIMMER MODEL -
CHECK VALVE YES
....................................-.------------......1........--------�' HEATER LAARSSIZE ,
AM
ALL CORNERS ARE 3' 18
GASLINE BY SUC
POOL LIGHT
SPA LIGHT 100 WATT
_%f `.._-�n-_--�" .° -CLOCKMANUAE
6 u FLA P �� � 9 A ELECTRIC BY SDC
. 32' 6" 3� BUILDING & SAFETY ELECTRICAL BONDING BY:
EPARTMEW TILE AND COPING
- CONDM®NA Y PECKING BY SUC, 10 1
ACCEPTED FOR RUCTION
GAS LINE FOR BBQ i� SUB1FG1'M1NS1'A�Q qS PER CONTRACTOR cannot assume
Rresponsibility for damage to
urbs, sidewalks, driveways,
29' 4cement slabs, sewers,
AND ALL APPLICAB CODES lawns,trees, fences, retaining
walls, sprinklers, telephone lines
X
LA� JU ? i BY AIAL Pr shrubs. When access is made
through a neighbor's property it is.
DEDICATED SUCTION - F 1 , 6,,. understood that you, the owner,
LINE FOR CLEANER have that neighbors permission '
-and assume full responsibility.
W W door W hb
Name: RUBER�Y, BOB, TERRY
AUTOMATIC CHLORINATOR W COMPUTERIZECD. JANDY k S IA JARDIN
CONTROLLER SYSTEM Address:
GREAT WHITE CLEANER - - -
W W W city: LA QUINTA
TRACT SPINNAKER COVE LOT# 45
PLANTER AREA { y„
alc W
Fa/c]
POO/i
3'+ f O { SHOW ROOM
73-011 COUNTRY CLUB DR. STE. F-4 -
MRSTE COPY PALM DESERT CA, 92260 aa�
250 PHONE (61 9) 346-4032
LIC # A-574127 03Gt3