9707-033 (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
/ti74127 A.
Date Signature of Contractor
OWNER -BUILDER DECLARATION
8/31/97 `
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.
(�d 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 issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This secltion�ieVetltn8t be completed if the permit valuatio-6741 rq$rO0.00 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: 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 nereoy made tb 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.
ignature (Owner/Agent) Date
BUIDING PERMIT PERMIT# CONTROL#
5482
DATE VALU TION ' LOT 9707.033 TRACT
f 13.�I12.fiI4 .
JOB SITE
APN
ADDRESS
a7,: -"n V1 A KA n NT I G.0 11
443-1 7,W1111127
OWNER
NTRACTOR/DESIGNER /ENGINEER
CANADAY R COMPANY
STEVE QODSON CONSTRUCTION
1570 8R(_iri.('i:110.1:,I: 0NV DRI:VE, SUITE 208
73-011 COUNTRY rl. UB DRIVE, M, F4
SANTA ANA. CA , 92705
PALM DESERT - CA. 92250
64}'34-4032 CI3I..i/ 1044
USE OF PERMIT
r.,
POOL AND SPA. ONLY
POOL A*1llIO.R. SPA 13.401.00 :LS
V-40 UV A'3TEM COST OF CONSTRUCTION
X3,4I31.�ti .
.P.E RMITiME SUMMARY
KAfd CHEXX E1113 101-M-439-328 59445
CONSTRUC(fION':FL:) 101-000-4.18-000 s1S3.0o
hair -1 tANICAL rEE -- POOL 1.01-600-421-000 S7rI.f3i)
RLFCTKICA.L:FM- — POOL 101-000-020-000 545,00
PLMMING FEE POOL 101-M-419-000 $27.00
,! S -013 -TOTAL CON MUC ION AND PLAIN, CHECK
$348.45
LESS PRE -PAIR ETES
$1.00
TOTAL PERMIT VEC.411l1.f,1. NOW
$348.45
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck 2 g 7
Exhaust Fans
O.K to Wrap 4F7
F.A.U.
Framing fCompressor
Insulation 7
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 k
Approval to Cover'
Equipment Location
Underground Electric
Under round 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
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)
€ CONTRACTOR cannot assume responsibility for GENERAL SPECIFICATIONS
T damage to curbs, sidewalks. driveways, cement
slabs, sewers., lawns,trees, fences. retaining SIZE 12.6. X 26.6 -
• .F walls, sprinklers, telephone lines or shrubs. AREA 350 _ PERIMETER' 80'
• When access is made through a neighbor's. DEPTH 3X5
r property it is understood that you.'the owner, TILE CHOICE GROUP3 SQ.
t K6ve that neighbor's permission and assume full.. RBB SPA +61' -
'responsibility. COPING CANTILEVER
. , DATE signature POOL CAPACITY 12,500 :GALS
PUMP CAPACITY 103 `' GPM
_ MOTOR HP STA RITE HP 1.5
r r MOTOR HP NIA HP
t FILTER STA RITE 300 SQ FT
FILTER RATE 103 GPM
LAKE FRONT ' I ni E Al LY HEATER LAARS SIZE 400 BTU
'`STORMDRAIN ACCEPTED FOR CONSTRUCTIONTURNOVER.. 2 HRS
EASEMENT - - SUCTION LINES 2 "
SUBJECT TO INSTALLATION AS PER RETURN LINES 2-1.5 "
SKIMMER MODEL "
CHECK VALVE YES
GASLINE BY SDC - FT. 50
T _ AND LL APPLICABLE COD S.
POOL LIGHT 400 CLOCK T104R
_AIR PIPE Q ELECTRICAL BY.. SDC 100
— �� - .
- " BY AUTO -,CLEANER N/A
14' CHEM. FEEDER NIA
PLASTER COLOR WHrrE.
DECK BY n/a SQ. .
DECK COLOR
BACHOE STEP FT.
DIG OPEN WALL
SPA SPECS.
ACCESS slzE 6' .RAISED . =6"
'P%LLffE 1 WATTS 100
RI LEVEL SEATS 22" 24" 27"
11-6 _6,. DESIGNER DAMWALL TOP TILE
8'-0" DAMWALL 6 " X 6 FT..
6,-01, \ / RANDY SPILLWAY SIZE -3 "X 12-SWIDE•..
911
-
_- DATE SPILLWAY X OPEN CLOSED
• .. _ - _ , k �. _ --... _ _,. 6--/23
- - -
_ Name: CANADAY AND COMPANY'',
16'-9"
` PULL DIMENSIONS Address: 47-590` . VIA MONTIGO -
HIS PO
OFF TINT
LQ
- t _ ; •
..TRACT LOT# 250 .
Dodso.
D
COVERED PATIOPools-
f5'
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E
f
'� PALM DESERT. TEMECULA
o H
73-011 COUNTRY 28910 RANCHO
I; CLUB DR. STE F-4-• CALIFORNIA RD.
} i PALM DESERT STE 206
NO E: tANDSCAPE AND FURNITURECA. 92260' TEMECULA CA.
} r ARE SHOWN FOR ILLUSTRATION 92590
(619) 346-4032. (909)676 -SWIM
RESIDENCE ONLY AND ARE NOT INCLUDED.
LIC # A-574127