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
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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