9905-287 (RPL)LICENSED CONTRACTOR DECLARATION
"I hereby affirm'under penalty of perjury that I am licensed under provisions of
14%v^hapter 9 (comrnencirig 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
351 i'� C13� /�/J/f 01f311V
r lj'J�
Date Signature of Contractor/`/` !!yy
OWNER -BUILDER DECLARATION
I hereby affirm under per alty of perjury that I am exempt from the Contractor's
License Law for the following reason: "
1, 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). .
O I'am exempt under Section B&P.C. for this reason
Date'. Signature of Owner
WORKER'S COMPENSATION DECLARATION
F
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
Section 3700 of the Labor Code,, for the performance of thework for which this
perFnii-is issued. My•workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
IST- 1Ts6V14ti 2119.9 U,,yCi ty 3�R
(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 erhploy any person in any manner so as to become subject to the
worke'rsi-compensation laws of California, and agree that if I should become
Subject to the workers' compensation provisions; o ASec 'on 3700 of the Labor
Code, I shall ort wcomply with those provi S✓
Sate: : S �� +Applicant A 1
Warning: Failure to secure Workers Compensation cov rage is unlawful and
shall subject.an employer to criminal -penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees..
IMPORTANT: Application is hereby made to the Director of Building and Safety
for a.' permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at '
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&';hold harmless the City of La Quinta, its. officers, agents.and employees.
Z Any permit issued as a result of this application becomes null and void if
Work• is not commenced within 180 days from date of.issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation'
I certify that I have read this application and state that the above information is
eo rect: I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize. repJJ.e�ntatiJesd6f this City fo enter upon
the above-mentioned property for ins ec on purposes:
i,$ignature (Owner/AgDate
BUILDING PERMIT PERMIT#9905437
DATE / VALUATION LOTTRACT
/
JOB SITE
APN
ADDRESS 79-905 V1.4. TQ41EQ9f
r
OWNER " '
CONTRACTOR / DESIGNER / ENGINEER
VACAMN POOLS
.�w-905 V1A'i'RIESTE
951 2DONA—LLiSO :ROAD
LA.+;;iLQN'['A. CA- 92253
i.,UfCER(+iE Vti#:rIX CA 92?1%
(760)148-6045 (J11N 4335
USE OF PERMIT
POOL A1+11` OR S'Rik
POWSPA 7.fa L i' - i4i:ilad&R31i3MIMi;<" IVtWrk BE 114 PLACE AT
PRIS-"PLASTER. tf aVIO<. TION
l;i (•AN.WOR. &PA
,te,N i'I Ni kP144;D C08T OF C13 )INSTRV CT 10,
12.000.100
K!"IRMIT,,'��EIIi/1,�.l�'��1�.t�15�+ V {'Qp
y(�i �(�( }f� i�j y
P11 AN E.a[.SK1M1WX F.F.F. R4/2'"�dV4f''�.7.r��.318 $8 .75
�
rc�.nf;3'±�cf•sf,'2t�,�t'�;�.� �< l•lJl-iitiQ..:�i•�..(i'tlj �f,��5,rt(f
I' IECHANvvICAL F -FC -.- POOL 101-(3W-421-01,110 .dm
iu ECT RICAf.,1`-r � — _PWL 101-600.420-000 $45.00
'PLLAt MT:f<O k';J, -.- INDOI, $27:i:Q
5i1 d'r: AIs tt�# i� iT !'4r1+1AN1- ?T:ANCHEJCK
`` RKE-RAYDFT
LESS
$0.00
1 Stg' .f�lf� 8'i RhI c
& 75 "
JUN 011999
� .
tom,,.
v " • � ..-;-r..
,REaiFl1r T Ul-
,AyE'�� qt
��
By!
DATE
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
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
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)
�VACATION POOLS & SPAS
9522 Donaldson Road
Lucerne Valley, CA 92356
(760) 248-6045
(760) 248-2919 FAX
go Lic. #C-53-351673
Sales Locations
Bermuda Dunes, Irvine,
California City, Rialto,
z �3 Lucerne Valley
1 800 999-1811
GENERAL e. SIZE 3
SPECIFICATION
7
AREA PERIMETER
-
�
A+&
/�'/ 6?� ` �� DEPTH 3 � — S
'
t TILE CHOICE 6--p-Jr-SQ.
RBB.
COPING CA.ns-F •
POOL CAPACITY GALS
�4,�-ler PUMP CAPACITY GPM
- MOTOR HP t^ P HP
lt MOTOR HP I h P • HP
FILTER CO -v-+, 300 SQ FT
FILTER RATE GPM
- , HEATER A AAA" SIZE 33.3.jo^6TU
" -�- TURNOVER HRS
,-�^ SUCTION LINES a„
RETURN LINES a - V/
N°' S N y SKIMMER MODEL 5f� A`+dff
- . �� �s „1;� kGV� S e �� 6 �� L a•+ S��i eget i ��_+� CHECK VALVE '�A c /
MSC ��01� z , . �� GASLINE BY U.P. FT. /� -l.
SQ a GC,'Ep�IG o S �a
ELECTRICAL
LE LIGHT L/TR CAL BY c , P FT.00K' ��e5
_(O Sw� AUTO CLEANER /`/ o
CHEM. FEEDER A/ n
i C��ES PLASTER COLOR
ALL �PpL1CA8�E ��S SQ.
DECK TYPE
�Y
p,�1D STEP FT.
H SPA SPECS.
v 5 '18 SIZE (o RAISED la "
V LITE -e 5 WATTS to 0
DUAL LEVEL SEATS a1'' t- aV "
DAMWALL
DAMWALL TOP T 'I r -
SPILLWAY SIZE 18"X (,'/WIDE
CONTRACTOR cannot assume responsibility for DATE SPILLWAY c 5
damage to cubs, sidewalks, driveways, cement 5-.1). 1,� #JETS
slabs, sewers, lawns, trees, fences, retaining walls,
sprinklers, telephone lines or shrubs.Name: Gt
When access is made through a neighbor's. property
it is understood that you, the owner, have that Address: �g -qps lJ ti cy %r i e5'
neighbor's permission and assume full responsibility -
City: L- Quc /v�g
DATE
SIGNATURE TRACT , l.� u ,,� ,-' � LOT# _5