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9610-017 (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 5`1144127 ti+. 1.s!"i"1 i!) 7 Date %f'�i 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 )icensed 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 the, Labor Code, for the performance of the work for which this permit is ss0ed? �ilj/" %1kers' compensation insurance carrier [&' p iicy 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' compensatioNrovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions,.. Date: A1111 Applicant— Warning: pplicant 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 cora"-,pct. I agree to comply with all City, and State laws relating to the building constructio-and hereby authorize representatives of -this City to enter upon the above-mentioned property,46r inspectionpu poses. ..f r Signature (Owner/Agent) BUILDING PERMIT PERMI �i���� $��� °°NTR°`" 4181 DATE VALUATION �IL�„fi{);�,� LOT, TRACT JOB SITE 47-817^ �).?1;KI)IN ADDRESS APN OWNER CONTRACTOR/ DESIGNER tt tt' II y �y�11 GG 16-3-5 alif 0$ {C+94Eil7 T/ENGINEER .J"I vF Ir1iVIS IN �A r t.r Lt.� , fi r CAA.!IIftDItA,L CMY: CA 92234 qM-391-6007 fu 1 1 e'n C113411 411 t 044 USE OF PERMIT POOL ANDA -At 15Flik PM>t,. AAV 'it,A ONLA' .. •,i. 1'1.1YL/ 1S U7'ti LNr�i i!. 1 Lur9 RIS ISYl4AO*!, A' / CVSt.7.71, @aOINI1T RlJ4,M. GIN 4,500.04; PLANC,ItE`} M? -lot-M10-439- ' 318 C ONS`C'RUC,":fb:N FIRM ' I.0!-',3i1C A1;1 -0W. 5162.00 t4,1isC#W1QCA1_. F - POOL 1011-000421-M) $24.00 .31NO1+C E -- f'c)di,.. ti)t-O0(1_4I3-4%()C) $;1 06 P):f1Ml mi isrmic-rioN :AND PLAN C EC:4 53363.30 LESSP.Rl.-r1 a,'': FEES IM`/lL PERMIT FIrITS DIDE;ufO'1+6' $0.00 $363.30 .. RECEIPT DATE BY DATE FINALED INSPECTOR 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 Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping Af PLUMBING APPROVALS Gas Test Electric Final Waste Lines Neater 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 COMMENTS: 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) SpA SP CS. I ('+ C UiT-',`V[T1=ii.:'Jia�..C.ial-,1 •ii 0-1J Y 7'spa raised 6 " pR - SIZE 7 SIZE 14 X 28 AREA 294 RAISED 6' " DEPTH S° I LITE 100 WATTS SHAPE PERIMETER 74 t TRI LEVEL SEATS TILE SIZE 3x3 22" 24" 27"6 ' - TILE COLOR TBS DAMWALL WIDTH - COPING CANT 21'+ 16-6 " W W . od PL ' X AIRLINE 13' # 28r 0W-8" %{ \ I / ` 3 t 11'6" I 16' 13 • b_ W door W ' PA S ' 41 W _ W { j box/light. Switch i� AUT FILL j� j jjam�.:,, _ . _. - �:_%%,�©©, �" ���� 11 Jj P 1 ti %f n� [b`` _ 22'+ W W O D �, ;q. �I ' SPILLWAY SIZE . 3" X 12° SPILLWAY OPEN X CLOSED # JETS 4 PL - - - S COPING COLOR TBS POOL CAPACITY 8000 GALS PUMP CAPACITY .90 GPM MOTOR HP .Starite ' HP 1, FILTER starite 300 sQ FT -FILTER RATE 100 GPM TURNOVER' 2 HRS SUCTION LINES 1 RETURN LINES " MAIN DRAIN' :. 2 SKIMMER MODEL dual port CHECK VALVE no HEATER LAARS SIZE '250.000 GASLINE BY SDC POOL LIGHT 400 SPA LIGHT 100 . CLOCK .220V ELECTRIC BY . S.D.C. ELECTRICAL BONDING BY: S.D.C. TILE AND COPING 'S.D.C. DECKING BY S.D.C.597 sQ ft, SDBUFF COLORED SALT CONTRACTOR cannot assume responsibility for damage to i curbs, sidewalks, driveways, cement slabs, sewers, Iawns,trees, fences,. retaining walls, sprinklers, telephone lines or shrubs. When' access is made the ugt tghbor's property it is DE IGN un ers o a you, a owner, �_ have that neighbor's.Permission BUILD�I4G SAFETY DEPART .b` ISE ;' 3 r 9$ and assume full responsibility. CONDITIONALLY q 'ACED®rDONTRTf Name: CENTURY S IECTTO INSTALLATION AS PE 3Address: 47-87 Cit JAIZDI1v City: LAQUINTA LIGHT WITCH - TRACT SPINNAKER LOT# 35 SAND ALL APPLICABLE CODES ....��� � �> DATE , . , =� DY Dodson POO/W SHOW ROOM . ' .. 73-011 COUNTRY CLUB DR. STE. F-4 • OHM COPY . :PALM DESERT CA. 92260 PHONE (619) 346.4032 LIC # A-574127. N� I