9708-136 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Cbapter 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
:574 1,27 A 9131l97
Date Signature of Contractor
9 ,
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.
V) 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 v 17(34f) Policy No.�
.y n. ••.
(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;Fand agree that if I should become
subject to the workers' compensation p ovlsions of Section 37008
Labor
Code, Ifhall forthwith comply with t oeeprovisions'/!
Date:Applicant = Y �
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
I 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
tKe above-mentioned property forrnspection purpojses.,_.--
Signature (Owner/Agerit) ./ : �../ Date
BPERMIT# CONTROL#
BUILDING PERMIT "'�"�-�•�; 5809
DATE VALUATION %12,928.0411 LOT TRACT
,1 (ti
JOB SITE' +�7-Sll. 1A �.4.RIF- T
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C A:At 7 Y ,. f Citi; 6'A.'d4-
�; ntirlr 11.:11)SC; t I
1570 BR.OtABALLO 4208
7 +•ti1. i ODUN"1' Y CLUB D'<tt1 U, 'SrE. F4
SANFAANA CA 141700
PA1.,1 DESEU (7A 9'T.*60
f 76MI/ki -4012' 011Lit 10,14
USE OF PERMIT
1",.rd.. A.NID 0M.i;
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LEIS PR r1_11 AND 1:1.:�1:i
• a_,(j
RECEIPT
DATE
BY
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
BLOCKWALL APPROVALS
POOLS - SPAS
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 Q
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:
7"
I
2 V_6
OPTIONAL DECKING
IN DOTTED LINE CONFIGURATION
�Zll
14'
I
CONTRACTOR cannot assume responsibility for I GENERAL SPECIFICATIONS
slabs, sewers, lawns.trees, fences, retainin_a
walls, sprinklers, telephone lines or shrubs.
When access is made through a neighbor's
property it is understood that you, the owner,
responsibility.
DATE
nature
CITY OF LA QUIfVTA
BUILDING &SAFETY DEPARTMENT
CONDITIONALLY
� ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
22s
t
E
AND ALL APPLICABLE CODES
- I/ ? - BY C)
"r—Frc� 6D-f�
NOTE: LANDSCAPE AND FURNITURE
ARE SHOWN FOR ILLUSTRATION
ONLY AND ARE NOT INCLUDED.
DESIGNER
randy
DATE
8-20-97
SIZE
14 X 28
AREA
300 PERIMETER 77.5
DEPTH
3x5
TILE CHOICE
group 3 SQ.
RBB.
spa at + 6'
COPING
cantilever
MOTOR HP
1.5 HP
MOTOR HP
n/a HP
FILTER sto rite
300 SQ FT
FILTER RATE
103 GPM
HEATER LAARS
SIZE 400 BTU
TURNOVER
2 HRS
SUCTION LINES
2 "
RETURN LINES
2 o 2' "
SKIMMER MODEL
ameri can
t'U CrV \!AI \/C
ues
GASLINE BY sdc FT. 50
POOL LIGHT 1-400w CLOCK t 1 04r
ELECTRICAL BY. sdc FT.
AUTO CLEANER n/a
CHEM. FEEDER n/o
PLASTER. COLOR, white
DECK BY others SQ.
STEP others FT.
SPA SPECS.
SIZE 6' RAISED +6'
LITE 100w WATTS
TRI LEVEL SEATS 22" 24" 27"
DAMWALL 6 " X OFT.
DAMWALL TOP tile
SPILLWAY SIZE 3-X 1 2 -WIDE
SPILLWAY xx OPEN CLOSED
# JETS 5 UPER LOWER
Name: conaday and conaday
Address: 47-815 via trieste
lake la quinto
City:
TRACT LOT 48 LOT#
AM
dr'ty5:r+
lood4f
l
Poo/w
PALM DESERT TEMECULA
73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
PALM,_ . SERT CA. STE 206
TEMECULA CA.
9226$ 92590
(619)346-4032 (909)676 -SWIM
I Ir : w—I---7A 113-7
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