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9709-103 (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 1of the Business and P. ssionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date ' 5711127 A tip 11i") /4 VDate Signature of Contractor „ ` 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. ( I have and will maintain workers' compensation insurance, as required by Se bon 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.V 01 (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�pyrovisi. AIi of Section 3700 of the Labor /Dode, I shall forthwith comply with those provisions.' ate: !`E2,4 ,3 Applicant ' 4 Warning: Failure to secure Workers' Compensation cverage 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 construction, and hereby authorize representatives of this City to enter upon t e above-mentioned property1for inspection urposes. . Signature (Owner/Agent) .'./ Date %i BUILDING PERMIT "",T*�iiliU _111.3 DATE r f VALUATION ,sl 2,12ii w LOT V MI OWNER APN CONTROL# TRACT 5932 CONTRACTOR/DESIGNER/ENGINEER CAN.ADAir &C.`(WIPf NY 9fTAIrl.Di,'DS(01CONS"F€1:l.C3110M 15 70 .B.KCXJat' HA1.,WiNe' /1 OR 73-011 COUNIU i'' Ci.C. R DRIVE , ' M. F/1 SANTA NINA t: A 92705 PA LN -1 Dr-S13WI' G''A, 9`2A10 if. 7(4)";14fi-<l032 CJSLP 104.11 USE OF PERMIT ttf.,0i. SPA ; 2.9,1 .00 %.:y tr-STaALUI Mita `O � 0,t 4�f,.N mr � a,Vi. PERM iit seas;; iAPWARV f;'!, ty N' F:'.i df+11:"1:.1-�;: k 01-�.3fi4')-�;:;a.3 i � tk9:� �► Cw IN,141'111li—l'tON l,'Ftr 10d-ttNI-411R-000 nf1 5=x,1: -- POOL !1,13-000-121-ow�r::t ttt► 1�t.L1A�1f�t1+l+�k'1:1•-1'Lffw+I, fi?3-t?tYJ�t!`f�t?�U �:'�s�r) d A ss if' t'CYi'A!,t"n4'siIRI.If''VIONA'N0PI,ANrflECK LEISS SEP 2 5 1997 f4fAl, PF'RIMT VFV;,% 0113E NOW DATE DATE FINALED I INSPECTOR A Jw�f.Gf3+i YJ 5113 60 J`P-0,f)(i $3J3.60 INSPECTION RECORD OPERATION DATE INSPECTOR G BUILDING APPROVALS OPERATION DATE INSPECTOR 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 CoverOF 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 OX 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: p/1 _— — —• • • rva�IV 1 CONDITIONALLY ACCEPTED FOR CONST RUCTION SUBJECT TO INSTALLATION AS PER D ALL APPLICABLE DES BY 05 CONTRACTOR cannot assume responsibility for 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. responsibility. DATE -air pipe p/1 ACCESS BACKHOE ature NOTE: LANDSCAPE AND FURNITURE ARE SHOWN FOR ILLUSTRATION ONLY AND ARE NOT INCLUDED. GENERAL SPECIFICATIONS , SIZE 12 X. 32 %REA 300 PERIMETER 78 )EPTH 3XS -ILE CHOICE GROUP' 3 SO. RBB. + 12" TOPING CANTILEVER MOTOR HP STA RITE HP 1.5 MOTOR HP N/A HP FILTER STA RITE 300 SQ FT FII TFR BATF 102 GPM HEATER LAARS SIZE 400 BTU TURNOVER 2 HRS" SUCTION LINES 2 @ 1.5 RETURN LINES 2 " SKIMMER MODEL AMERICAN CHECK VALVE YES GASLINE BY SDC FT. PLAN POOL LIGHT 400 W CLOCK ELECTRICAL BY. SDC FT, PLAN AUTO CLEANER N/A Name: conin ja anis Co_ Address: 47-850 VIA TRIESTA Cjty: LA QUINTA TRACT LAKE LA QUINTA LOT# i Q j AIM PALM DESERT TEMECULA 73-011 COUNTRY 28910"RANCHO CLUB DR. STE F-4 CALIFORNIA RD. PALM DESERT CA. STE 206 92260 TEMECULA CA. (619) 346-4032 90 90 (909)676 -SWIM 11C : A-574127 PLASTER COLOR WHITE DECK BY OTHERS SQ. DECK TYPE STEP FT. SPA SPECS. SIZE 6' RAISED LITE 100 WATTS RI LEVEL SEATS 22" 24" 27" DESIGNER DAMWALL 6 " X 6 FT. RANDY DAMWALL TOP TILE - SPILLWAY SIZE 3 _X 12" WIDE DATE SPILLWAY XX OPEN CLOSED # JETS 5 UPER LOWER 9-16-97 Name: conin ja anis Co_ Address: 47-850 VIA TRIESTA Cjty: LA QUINTA TRACT LAKE LA QUINTA LOT# i Q j AIM PALM DESERT TEMECULA 73-011 COUNTRY 28910"RANCHO CLUB DR. STE F-4 CALIFORNIA RD. PALM DESERT CA. STE 206 92260 TEMECULA CA. (619) 346-4032 90 90 (909)676 -SWIM 11C : A-574127