0001-172 (RPL)LICENSED CONTRACTOR DECLARATION
herbaffirm 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
3 _1 14 1.2 153. 0,&31f20i
1`
Date ' 'i ~+� Signature of Contractor
VA
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.
( ) 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 workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
fxi+ �'Y'r F'n; j,il1 •e^n ir) F rrn 0
n..a1`•i jl i4r10
(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
wo� ers' 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. '^{�
y5ate: 1 f: , /, I 7 Applicant / ' ( I z:' C �`•!
v
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to ,the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the. City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
co0n`struction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.,
e
/Signature (Owner/Agent) r ° .'.n _'� Date f'
BUILDING PERMIT
DATE VALUATIONJif)?,��1i�} (►J LOT
JOB SiTt
ADDRESS ^ 4X705 705 "A SUERRik
OWNER
tiirr�" lilaiin rF'1rio lut,
4-81. P DEL DJOS 1.11CCLE
11NI 1AN WELLS CA, 92hO
USE OF PERMIT
PERMIT# -
-� TRACT teti�<i�
APN 431-43144)
CONTRACTOR/DESIGNER/ENGIN
Ai ft�'A�"i"t7/�rlhrV'Z'131Cr•'r`7Y�1�T
74-'160 VELA 1 DO K0
VALN4 fAiSbUG' CA 92260
POOL Ui+js:: - Ai.r: k1P-„,isAR91 A&S 6RALL 0E, �N 1AI.Akl° Al'
"„` '• V,01041, ;anti
J•e r1 Y, i
1010601.00 .i.5
9,`"VIrl"N A`i yi! Iris Ei'P l484 � WQ1VVYa T41rrrVJ,%:�i
k'rtVA allfk, YX,rr MSO .l VP' x. 1.9,7 k.'+`.4.J4 Aan_n
4'49$.ri'itlli .$'`@irt'i+.:
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
q6Z9
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
^ ------------------
coNTR,gCToR cannot assume responsibility for GENERAL SPECIFICATIONS
r t damage to curfis, sidewalks. driveways cement
SIZE jL 9• •
• - - - • - • slabs, se�,vers, lawns, trees, fences, retaining
walls s klers, tdepho AREA O-. PERIMETER
__grin ne lines or shrubs.
_ • P fi^ When access is made throupfi a neighbor's DEPTH s ' ,
ro ert`{ it is understood that you the owner TILE CHOICE bOSO.
RE -INSPECTION :FEE OF $30 hay t�hac neighbor's permission and assume full RBB.
Y
WILL BE CHARGED IF THE APPROVED Iy ; responsi5.ility. OPING . p.
AND JOB -CARD ARE NOT ON i DATE L CAPACITY - GALS
PLANS. _ s>< tnr.,e -
THE SITE FOR A SCHEDULEDo PUMP CAPACITY 1 Zd• GPM .
.
INSPECTION. _ ;� ' MOTOR HP
I. L HP
NO IXCEPTIONS! _ MOTOR HPHP
- FILTE . oy a
'�'• 'OQa SOFT
FILTER RATE 1 5 A GPM
3 HEATER. 4a OI$IZE yoo 000 BTU
t TURNOVER HRS
ry ! SUCTION LINES Z .
f t i RETURN LINES
i
i SKIMMER MODEL 91 ' 6' eo4 PJ
CHECK VALVE
• •_ 1. f Q � X 3 � P'°. �� N � . GASUNE BY 60N4r4p�-s FT.
POOL LIGHT @ S CLOCK
5A F`( i-re4 9is
, ELECTRICAL BY. (p►tFf&evfT '
AUTO CLEANER
',. CHEM. FEEDER --
s _ PLASTER COLOR
a DECK BY C) SO.
Z ' DECK TYPE O
—t> STEP FT.
s'ao s t f ti
^ t SIZE RAISED
LITE oZ WATTS
0-1 JJJ o
x 7o_ fylp"'#� ��5 ( TRI LEVEL SEATS
r (�
AJ 4A DAMWALL X FT.
( a DESIGNER DAMWALL TOP
' 1'�• SPILLWAY SIZE X WIDE.
DATE SPILLWAY OPEN CLOSED
i - 1 .1�0 # JETS UPPER LOWER
I ,
Name:
Address:,4 6 %%j S✓ '
9
i
/ -
ALDERETE
r
1 _ I POOLS • SPAS • LANDSCAPE
• I 74360 Velardo Drive M. (760)77 "-3293
/' o ... 1 t w Palm Desert. CA 92260 Pgr. (760) 833-7632
State Uc.# 331412 Fax (760) 773-3293
- i��