9802-031 (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'
A Q131./99
/DateSignature of Contractor.4V,6',JC-.�,�/).",i
OWNER -BUILDER DECLARATION'
I hereby affirm under penalty of perjury that I am. exempt from the Contractor's
License Law for the following reason:
(' .)' 1,. as owner'bf 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).
1, as owner of the. property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code)..
O I am'exempt. under Section - B&P.C. fdr 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 1 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 w6rkers' compensation insurance carrier & policy no. ,are:
Carrier Policy No.
ST ATEFUND 1242619-9.7
(This.section need not be completed if the permit valuation i,s.for$100.00 60ess):
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,Lshall ose provisions
ply with those 'Q
Date: cant—
Warning: Failure to secure Workers' rnmppn,.;siinn rovOrRgo ic unlawful and
shall subject an employer to criminal penalti ' es and civil fines Up i to.$1*00, 1 000 in
addition to the cost of compensation, damages as provided for in Section 3766
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
o .
for , a permit subject to the conditins and restrictions . . set forth on. his
application.
1. Each person upon whose behalf this application is made & each person at
whose requ6st 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 har4ress the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and v6i&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,upod
th. e above-mentioned property'ior inspection purposese
/Signature (Owner/Agent') llle��k_xio
Date? _4
PERMIT#. CONTROL#,
1,_ Ir
PERMIT
-BUILDING
DATE VALUATION LOT -TRACTi`
$13,40.1.00
JOB SITE
APN
ADDRESS I
47.•040VIA AIGNITIC.0
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CAt4ADAY.AND C6
Erf EVEDODSON COMSTRWTION
I _510 BROOKHA.LLOW #208
73-011 COUNTRY CLUBDRIVE, S" 3. F4
SAWA ANA CA 9270-
PALM DESERT CA - 92260
(10))346-40.2 C8L# -1044
USE OF PERMIT
rl M 4;1
'POOL AND SPA 4 IeM 47 7'/m4..
0,C eAJ_C'*4P
POOL ANWOR SPA I3,401,00.LS
ESTIMATED COSI OF CONSTRUICTION
13,401A)
PERAW FEE SUMMARY
PLAN CHECK FEE 101-000-439-3:18 $99,45
CONSTRUCTION FV 101-000-418,400 $133,00
MECHANICAL SLE - POOL 101-000-4214)0
EIEC'IllICAL FEE - POOL $45.00
P1XNfl31N0 IFFE - POOL $27.00
SUB -TOTAL CONSTRUGOON.AND RLIVN (:CWCK
b3 tS.4
,ESS PRE-PAJOVEES
$0.00,
PERMIT FEES DUE NOW
$348.45
RECEIPT
DATE
1BY
DATE FINALE.D'TINSPECTOR
M
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
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 AW
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Pictures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
P/I
i C-QNIHAC_T_O1-c-ann_otassumgL-Le:spoa�ibility_for GENERAL SPECIFICATIONS
siamag_e-t-o curbs_,_sidewalka,_dri�-e-wa-y-s. mnent SIZE 14'-6" X 30'
sJ.al�sl�e�rersla�ns,s,�en�e���etaining
wallsTspr_inkLur , t�pb-oneJ.inss�Lshcubs AREA 320 PERIMETER`�•7.7
When _acc�sJs_made-Ihrougt- neighbors DEPTH 3X5
RSP yet i �arld_erstQoA hat_y-ou,-the-o�cner. TILE CHOICE GROUP 3 Q 58
have t t naL9bboJ� permi -SID-n-and_assua full RBB.
SPA ONLY AT +6"
LAKE FRONT ; &-V- nslbdty COPING CANTILEVER N .
DATE signature POOL CAPACITY 1.1000 000 ALS
4:
PUMP CAPACITY 102 GPM
MOTOR HP STA RITE 1.5
_ MOTOR HP ,------------ Hp ----
+. r.
r
4
• FILTER STA RITE 300 'SQ FT
-9" r _
102 GPM
1 HEATER LAARS -SIZE 400 BTU
' _ 4 TURNOVER HRS
�..
SUCTION LINE 2 @ 1.511
_ — I S RETURN LINES 2
•
easement 10
'KlhlhlER•Ivl"DEL AMERICAN
HECK VALVE YES
+611 spa _ k :
P/A` \ _ GASLINE BY SDC FT. 50'
— — POOL LIGHT 400 W CLOCK TI 04R
1 11 1 11 < '/: ELECTRICAL BY: DC 200'
R10'-6" :... R4.-0 R5 -U FT.
AUTO CLEANER 5--------
V P/I CHEM. FEEDER ---
n�
lY
RT -0" ._. •- ._-....... 201-211...........:......_:.:_._...._.®� .........,. �'3'-6,1 PLASTER COLOR WHITE
� - - DECK BY
-------
------------- ,
OTHERS SQ.
\ DECK TYPE --
11 ' - ; - - - ------ FT. ------ _
STEP
R4 -10 P/A f 30'-0" SPA SPECS.
1 SIZE 6' RAISED +6"
..
R6' -O' - _
LITE 100 WATTS
L! SWITCH - RI LEVEL SEATS 2 411 2711
T SWI C: S T 2 2
1
it 9 y DAMWALL 6" X 8 FT.
DESIGNER _
�. TOP TLE 11
• DAMWALL I
— p/a i
SPILLWAY SIZE 3 "X 12" WIDE
r — — — 32'-3" - DATE SPILLWAY XX OPEN CLOSED
y # JETS 5 UPER LOWER
gas/elect 2-7-9s
F+ lyame- CANADAY AND CO.
® Add.nes
47-620 VIA MONTIGO
• r° k@ S'-3 Y �+ t LA QUINTA `
access LAKE LA LOJ 249
RESIDENCE 45 TRA_CZ QUINTA
covered patio i, backhoe
ry no .walls&Afsoff
7'-9" - Yet
MASTER
51_0BEDROOM r PALM DESERT • TEMECULA
lot 249 73-011 COUNTRY 28910 RANCHO
A10/7
CLUB DR. STE F-4 CALIFORNIA RD.
` • LAKE LA PALM DESERT CA. STE 206
NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA.
QUINTA I. 92590
ARE SHOWN FOR ILLUSTRATION (R1 -9)_3A6 --A-032
( ONLY AND ARE NOT INCLUDED. LIC # A-574127