9802-087 (RPL)_ LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
"':ihapter 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 "4127 A 8/ 11 9 .
VD
ate % Sign of Contractor~� g
OWNER -BUILDER DECLARATION
I hereby. affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( . ) , l', 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.,miect (Sec. 7044•. Bnsinecc A. Prrlfeccignalo
Code).
O 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
Sedlion 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:
Cartier Policy No.
S1 TE FUN 1'112679-97
(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
s4ecf to the workers' compensation provisions of Section 3700 of the Labor
Code, I. shall forthwith comply with those provisions.. ,
Date: ��+�+ Applicant / j- Z, I"V- .
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the. Director of Building and:Safety
for a permit subject , to the conditions and restrictions set forth on 'his
application.
1. Each person upon'whose behalf this application is made &eachperson at„
whose request and for whose benefit work is performed under or pursuant to"
any permit issued as a result of this applicaton agrees to, & shall, indemnify, ,H'
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any'permit issued as a result of this application. becomes, null and void if
work .is not commenced within 180 days from date of • issuance of such
permit, or.cessation of work for 180 days will subject permit to. cancellation.
I certify that I have read this application and,stafe that the above information is
correct`�I agree to comply.with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property, for inspection purposes.
l%
, Signature (Owner/Agent) - ��' Date.
PERMIT# CONTRBQO�L#
BUILDING PERMIT
DATE VALUATION LOT �Dif FD2-O$�% TRACT 6 4a
V
2/19/98 b23,40LOIi
JOB SITE
APN
ADDRESS
47-62$ VtA MONT.iGO
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CANADAI' & COMPANY
t,;
STEVt DODSON CONSTRUCTION
.1570BROOKROL:LOW DRIVE, SLUE 208
73.01.1 COL N''CRY CTAjB DRIVE, Sl lx. F4
SANTA, ANA CA 92,705
PALM. DESERT CA 92260
(7,60)3464032-, ' C.BL# 1044.
USE OF PERMIT
POOL & SPA ONLY, ilvvESTit�/1Tit7iV FEE iiv1PO5ED i c►t t'GN,Si`Ittlr, i n t:i
s'r P,TaD unwou r Pr mrcr .
FEB 1
9 1998
Ptom'` L AMMOR SM 13,401:00 LS
L�1TY i./ 1
in
r,19fIMAZ"CD CAST CDT COIeI§!'l2TJd.'"d'ION
PLitmff FEE SLf' WVRY
PLAN CfWC1 iT!.H 101-000-41139-318 $9.9,45
CC3'NSI'RUCTION ME 101-000418=000 $153,00
],Wa-,ST1QKr1C;'4FF.E :101-0004423-000 $153:00
LIAE l:MA:N1CA FFY3 10:1-000-421-000
ELEMICAL Ft� -- P06L 101-000-420-.000.
f,1LlJi*vr13:CNGFEE '--POOL 1.01-000^41:9-000
SUB -TOTAL CONSIALICTION,AKID PLAN C1.4LCR
St11 4_
LLSS :PIR -P�1R F X1;5
S0.00
TOTAL P'ERMiT FEWEIVE.NOW
S:tili.4i3
RECEIPT
DATE
BY f
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 PI . 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
0 f
Gas Piping
Gas Test
Appliances
Final
Q
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)
II
-- -- FREEHAND THIS F CS)NIRA-CIQ�an.aotassume�spoasibitity�or GENERAL SPECIFICATIONS
p. BOULDERS BY OTHERS } damage to�ur-bs, sde-wa.lks-driveways-cement.
l., SIZE 14 X 28. \
- --- '• slabs, sevver_s,_lawns,tc�es,�enees,_retaini.ng
1 walls spc kLecs, tel_e.ph_one_ii-oesor-slac bs- AREA 330 PERIMETER 74
PII A-Wh-ecLa-c-c-e.ss-is-ma.d.e-t4r-ougb-a-rj-e.ighb-or-'s. DEPTH 3-5
propor_t_y-t_i_s, undeistood that_y-ou:, the owner_,; _TILE CHOICE group 3 SQ
10-011 have t.h-at_neighboLs_permission-and-a.ssume_ful.l
RBB. +6" (Spa)
13'-9" reponsibilit_y_. COPING CANT"/ BY OTHERS
R4'-7 R6'-0" i DATE signature POOL CAPACITY GALS ,
PUMP CAPACITY 100 GPM
•
------ -- i --- --- r---6,4S�IEA1�—'`---------- MOTOR HP STA RITE Hp1.5
12"smo
- FILLTEO
HP kP
oR STA RITE 300 SQ FT
thband
;" /a FILSER RATE 90 GPM _
:..
P
400
R. 7
LAARS SIZE BT
i
.% / ...,:. ...
_ - RBACKHO -0"•
----..v. 2SUCTION LINES
- S
5 1 2'8''RETURN LINES 2-1.5"
'1• SKIMMER MODEL AM
----- '
25'-9" 9'8." :j a� YES
A I ,1 6 • a 11EiCK VALVE —
6 20t-31#_ "
SPA + .._._......__._.... __. ::: •.:. I. - - —----- –
13 �-
•� � ��,���' GASLINE BY S.D.0 FT.
5' I '�' POOL LIGHT 400 CLOCK 220V
- air line `� %' ELECTRICAL BY. S.D.0
; 7 _ 15A."4" .a—ET.—
spa ` h`' AUTO CLEANER
P
BUILD ...:
1
16 Cc);q`_'° CHEIVI.FEEDER
12 6
19 10 - 13 10 PLASTER COLOR WHITE
R4 - i. _ Ep
lF t i
EP ' �-' r' : OTHERS S
(I l I C `;'..� t DECK BY Q•
- -�!R /..' DECK TYPE
N.C i Su ,ECS ,
STEPS .
`R8 -0 ES SPA SPECS
13' ' Pp�,CABLE COD SIZE 7 RAISED +6"
AND ALL P LITE
i' __ f TRI LEVEL SEATS 22"24"27"
LL � 29 8 `
7. BY IGNER
DAMWALL 6" X 10'
21
LIGHT SWITCH I C4J J,D,M XETIL
SPILLWAY OPCLOSED
covered'
patio I� r DATE -#JEIS�
2-1 1-98
Llame� CY" " C DY
L�ddres 47 -AW VIA MONTEGO
Ory L d Z,S:•
5'-0 IRA.Z LK LQ LQT 2 5 8
PO O/S
MfiSTEH COPY PALM DESERT TEMECULA
CHO
CLUBIDR. OTE FmA ���i� N R6:`
PALM.DESERT CA. STE 206 �.
NOTE: LANDSCAPE AND FURNITURE 92260 '
TEMECULA CA.
ARE SHOWN FOR ILLUSTRATION (_6Ja)_3A6_z_4_032. 92590
ONLY AND ARE NOT INCLUDED. 0090-616_SWIM
LIC # A-574127