9608-069 (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 # Lic. Class Exp. Date
127 A
Date /Jif 40 Signature of Contractor SI_(/
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&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 that Labor Code, for the performance of the work for which this
Fa p t rte. t, 15V 3 f .t: ' �A, ; � �:
permit is Issued. My workers' compensation insurance card r po Icy 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 rovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those prowl Ion r
Date: IV, �d Applicant -
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 dateNof 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
S2nstruction, and hereby authorize representatives of this City to enter upon
the above-mentioned propefor inspection
purpo es.
Signature (Owner/Agent)ltf • •/���N�
BUILDING -PERMIT PERMIT►{Ivilff CONTROL#
7
DATE 4/ /96 VALUATION $14.5,00JA) LOT, TRACT
JOB SITE 47-850 VU JA�',C�:�N
APN
ADDRESS
OWNER v
CONTRACTOR / DESIGNER / ENGINEER
e i'`.T`1k Tlc is1F S
"['t�sJti DODS N �:���t;�'�1WC.i`it��t
1 5 S.1=) 9,11REL-1'1:' ..
6890 5rl t?P KLZ kD_ H9
SAN C,A,
(,AT141,'DkA-1, Cil"Y (:�A. 922 of
(619 2447_12 C:fi ,N' 10,14
USE OF PERMIT
POOL fes) SPIN ONLY LOT 4t
(:01STOV L{ INSTRtlC1,10144'
.a,41;�ti,4iii
NF;idMIT tieCE, SUM9tTARY
PLAN Ct4fiC K, F't 8 101,000-439-318 fU5.3ti
00iNS'f'Rt CTIO'Nr EE t.flt.:QQi X18$ S?4Q $1L'.tXJ
Cv11:CHX4IC.AL,ML- --POOL 10.1-000421-000 $24.00
F11(.F 1'1" I[CA4 VC.T. __ 1W)11 101-000-420-000 $45.00
P1.UMBVNCi.FXX- POOL J01-000-4191000 �27.rtt►
SUB-11YEM, CONS"t'RUC':17101 t ANS :PLAN ('.HECK
$361M
LX U -PAID 03ES
$0,00
. a At, N0wha�.�
..:
0 C T 1.1 1996
By
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECT0,i3
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas '
PLUMBING APPROVALS
as Test
ec ric Final
p
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
Y /
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:
SPA SPECS. GENERAL SPECIFICATIONS
SIZE T SIZE 21 X 34
AREA 590
�3 RAISED 12" DEPTH 3'6"x7
3' LITE 100 WATTS SHAPE REC PERIMETER 102
34' F
• F . 3+ TRI LEVEL SEATS TILE SIZE CHOICE GRP 3
2211. 24" 27" TILE COLOR CHOICE GRP 3
DAMWALL WIDTH 6" RAISE BEAM 12" & 6"
8'8" { F4010 3" COPING CANTILEVER
15 +" , SPILLWAY SIZE 1 X
i OPEN —2L— CLOSED POOL CAPACITY 23,000 GALS
12'R PUMP CAPACITY 95 GPM
I —------
S JETS.#-- --
4 MOTOR HP MAXI II Hp 1
.............................................. EQUIPMENT WALL
FILTER MOD -MEDIA 300 SQ FT
�.......................... t.......::.. :.....I.
BY SDC FILTER RATE 105 GPM
7' i TURNOVER 4 HRS HRS
s RETURN LINES. 2 "
R6, -0"
MAIN DRAIN .1 "
; ' 15'
SKIMMER MODEL U-3
Y
21' CHECK VALVE YES
15'+"- .............-----------.....-----:.._.........--m- HEATER LAARS SIZE 250,00Q�TU
N
'1 GASLINE BY SDC
+ I POOL LIGHT 400 WATT
SPA LIGHT 100 WATT
CLOCK MANUAL.
I ® R ELECTRIC BY -SDC
'r ELECTRICAL BONDING BY: SDC
TILE AND COPING SDC
10e I DECKING'BY SDC, 1413 SO. FT.
r COLORED SALT
j i0+ CONTRACTOR cannot assume
I I WALKWAY TO FRONT DRIVE BY SDC onsibility for damage to
"
l 13'6 I curbs, sidewalks, driveways,
20' j cement slabs, sewers,
lawns,trees, fences, retaining
hb W { dood W W walls, sprinklers, telephone lines
('
START POOL HERE or shrubs. When access is made
� `` ,
S . 1 W through a neighbor's property it is
understood that you,. the owner,
W f W DATE have that neighbor's permission
- ,. - • .- _ W. / and assume full responsibility.
PLANTER I ,
A P k �W ~f.,. aJc Name: ����/lo�Co-�JMDOTao D Y0
B� � & SAFE Ir l� ��r.
ANDIVO IALLV SPINNAKER COVEPLAN 4 'f SMOKE -TREE" a/c r Address: 167450 dOq dQaDPM
ACCEPT FORCOIWSTRUC;7�1' -1 MD QML LA QUONTA
ESMENCE OM'R -m; Tract- BOOKMAKER
SUBI'1=_CT ® INSTAL ATION A8C i L -n
�® LOT: . ,
A.�D AI APPLICA XE CO S
POO/W
DATE SHOW ROOM
73011 COUNTRY CLUB DR.#F-4,
--_ - i PALM DESERT,CA. 92260 UWQWE 61 E
In TER COPY � CO# A-57412746-403 DENWS