9707-036 (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
574127 A. 0131/97
Date 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 -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,
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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 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
WojJkers' compensation laws of California; .and agree that if I should become
s��ibject to the workers' compensation provisions of Section 370.0 of the Labor
Code, I shall forthwith comply witH those provisions.
Date: Applicant
Warning: Failure to secure Workers' CompRnsatinn rovarago 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 applicators 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'ift�
work is not commenced within 180 days from date of issuance of�such f:v
permit, or cessation of work for 180 days will subject permit to cancellation!
I certify that I have read thisapplication 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 .
ii.4 above-mentioned property for inspection purposes. yT
Signature (Owner/Agent)
Date t'
BPERMIT# °°NTR°`#
BUILDING PERMIT
!�707�036 5484
DATE VALUATION $.14,401.0 3 LOT 257 TRACT 2615,
..
SITE"29
ADDRESS 47-495 -VtA- MQNT1(,�0
APN 643-11JOB
OWNER
CONTRACTOR / DESIGNER / ENGINEER .
CA.NADAY & CO r1PAN
STEVE: DODSON COIN tRUCTi.(3N
i57tS 1 C3t�.K,1 i3%.f.Q'tX i}�t.i C:. t 1�'E xis
73-011 oouw R'y cLurs.i,1i'ciw, SIT- R
SANTA ALA CA 92705
PALM DESERT CA 922260
(760)346-4032 C13. 41 1044
USE OF PERMIT "
KJO .
K'*L AM VA, ONLY .
ti
POOL. .+Vd,l7T+: R SPA 11.3,401..00 LS
i> STINIA'l; ED G(AST Or, WNST ltUCTIO'N
13,401.00
i'E(Q'Nri t` .FEE SUMIiiA'RY
PLAN CHECK TER.
CONSTRUCTION Fm' 141-000.418-000 515.00
tvil4CHA:'j3ICAL.Fa- _.POQL., .10,090-42j-000
P_1XC1RJCAL FrX.-1'?OOL ilii, -M04- 2U-{Ji)0 �4i.tji)
PLUN413TNG FCE --.POOL 101:-000-419.000 $27.00
t
C) iCFl:AL CUO1`1,�NO P t.- Cki1�G1
S348.45
. .CO�1S'fRl
" 1,ESS PRE- I.D FIDES
10.00
.
TOTAL PERMIT FEE DUE NOW
$34&45
.1,
V.
RECEIPT
DATEBY
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills `
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -.SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings 2
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines Z
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)
LAKE FRONT
RAISED DECK/SPA+6"
IIP
IIPL
11
CONTRACTOR cannot assume responsibility for
damage to curbs,.sidewalks. driveways, cement
_ slabs, sewers, lawns,trees. fences, retaining
walls, sprinklers, telephone lines 'or shrubs.
When access is made through a neighbor's _.
PLproperty it is understood that you, the owner,
have that neighbor's permission and assume full
a• responsibility. .
DATE — sinature
GENERAL SPECIFICATIONS
SIZE 12 X 28
NREA PLAN PERIMETER ,r:y
DEPTH 3-5 �`
FILE CHOICE GROUPS 'SQ.
RFT- SPA+6" .
0 PUMP CAPACITY 103 GPM
R22 ai MOTOR HP STA RITE HP 1.5'
MOTOR HP HP
FILTER STA RITE 300 SQ FT
FILTER RATE 103 - GPM
HEATER LAARS .SIZE 400 BTU
S'S
TURNOVER 2 HRS
SUCTION LINES 2
t RETURN LINES 2-1.5
SKIMMER MODEL AM
.,''CHECK LV YES
11 r GASLINE BY S.D.C. FT -5:0
T'
+19 P1 POOL LIGHT 400' CLOCK T104: '
L ELECTRICAL BY. S.D.C. 100
AUTO CLEANER N/A
CHEM. FEEDER N/A
/.
1 �, PLASTER COLOR WHr1-E
+ DECK BY OTHERS SQ.
% l DECK COLOR. ,CHOUSE
' STEP FT. ;•
q 1 91 1 04 SPA. SPECS_
7 SIZE 6 RAISED +6"
jF LITE 1 WATTS •1.00'
fi`• RI LEVEL SEAT9_2211. 24 27"
M ❑ DESIGNER DAMWALL TOP TILE
i DAMWALL- 6" X 1 OFT.
JAMIE SPILLWAY SIZE 3 "X -12 "WIDE
DATE • SPILLWAY' X OPEN 'CLOSED
' # JETS 5 UPER LOWER
6-23-97
r'- Name:
CANADAY AND COMPANY
Address: 47-395 VIA MONTIGO
LIGHT SWITCH city LQ
- TRACT LOT# 257
SEE OWNER FOR EXACT ?. 7'-6" PL _
LOCATIONED
='
j box
C'
- - + J } ` T
CH PM14F
�> PALM DESERT TEMECULA:
73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT STE 206 '
NO E: LANDSCAPE AND FURNITURE . CA. 92260 TEMECULA CA.
' ARE SHOWN FOR ILLUSTRATION 92590
(619) 346-4032 (909)676 -SWIM
ONLY AND ARE NOT INCLUDED. LIC # A-574127