9709-102 (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 #„9,aY Lic. Class Exp. Date ,
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm underpenalty 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.
( ) I have and will maintain workers' compensation insurance, as required by
Secton,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 a t,1 _ f e r., - 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
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, I shall forthwith comply with those provisions.
Date: Applicant
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 hisg
application. g
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
”-vermit, 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
..tK--*above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDING
G
PERMIT :PERMIT# � CONTROL#
1L,lf�.a 59-33
DATE VALUATION .�s`� LOT TRACT
JOB SITE aA7i—;74 e.k,k.,%WO sM
APN
ADDRESS.
OWNER
CONTRACTOR/ DESIGNER/ ENGINEER
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USE OF PERMIT
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SEP
)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
Stab 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
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: IT
r
BACK/DIG
71-011
3
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
property it is understood that you, the owner,
have that neighbor's permission and assume full
responsibility.
DATE ___ signature.
CITY OF LA Q U ITA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONS"Ti RUIC T ION
SUBJECT TO INSTALLAT ION AS PER
A ALL APPLICABLE OD S
�s q�
BY a
III# No,
3
R
F NOTE: LANDSCAPE AND FURNITURE
ARE SHOWN FOR ILLUSTRATION
ONLY AND ARE NOT INCLUDED.
GENERAL SPECIFICATIONS
SIZE 12'9" X 2669"
AREA 263 PERIMETER 70
nF:PTH 3-5
GROUP 3
RBB. +12"
COPING CANT
POOL CAPACITY
GALS
PUMP CAPACITY 100
GPM
MOTOR HP STARITE
HP 1.5
MOTOR HP
HP
FILTER STARITE 300
SQ FT
FILTER RATE 90
GPM
WF:ATFR I AARC C17F 400
RTII
SUCTION LINES 2 "
RETURN LINES 2 "
SKIMMER MODEL DUAL PORT
CHECK VALVE YES
GASLINE BY S.D.C. FT.
POOL LIGHT 400 CLOCK
ELECTRICAL BY. S.D.C. FT
PLASTER COLOR WHITE
DECK BY OTHERS SQ.
STEP FT.
SPA SPECS.
SIZE 6 RAISED +12"
LITE 1 WATTS 100
RI LEVEL SEATS 22" 24" 27"
DAMWALL 6 " X 6 FT.
DESIGNER DAMWALL TOP TILE
SPILLWAY SIZE 3 "X'18 " WI
JAMIE SPILLWAY X OPEN. CLOS
DATE # JETS 5 UPER LOW
9-18-97
Name: CANADAY&CO
Address 47-820 VIA TRIESTE
City: LQ
TRACT LLQ LOT# 102
pff/w
PALM DESERT ' TEMECULA
73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. STE 206
92260 TEMECULA CA.
92590
(619) 346-4032 (909)676 -SWIM