0401-014 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed -Under provisions of
Chapter,19 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License 11 Lic. Class Exp. Date
C-53 I
Date /1l�Signature of ContractorVVI %� flfl"+•�+�'.,'`
f• 4r e a t 1 `
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).
O 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:
(:.);.. L, have and will maintain a certificate of consenrto self -insure for morkers'
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 the work for which this
permit is issued. My workers' compensation insurance carrier &'policy no.'are:
Carrier Policy No.
- EN1P'F.-3Jit13D dC313L '
(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 orthwith comply with ihoseprovlslonsd,
Applicant / i ..3' yl C.`,C-f=.tc.i�tti
/ ( ,.
Warning Failure .to secure Workers' Compe6sation. coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,00,0, .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 pursuan. Lto--
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 s=6
permit, or cessation of.work for 180 days will subject permit to cancellation:
e
I certify•that I have read this application, and state that the above informtion is
correct: I agree to comply with all City, and State laws relating to the b ilding
construction, and hereby authorize representatives of this City to enter upon—
the above-mentioned property for inspection purposes: /
• � 1
Date
.-,Signature (Owner/Agent) ii�jT �'���� �'` /dL»._.
ti,.
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT �� "C'da'0� TRACT
r; ,( 4/ �1 ,tf00.r1U
JOB SITE
ADDRESS
78-59,15 V.M VT:,•1T, ;ix
APN
OWNER
CONTRACTOR /DESIGNER /EN1NNEER
d✓L1 LjS
.
SrYkaVJXV4LOS pWy SfP S
78.915 vyv�v1_•= rAmA
40880 340UN'?AW COVE D.RR97' 994
1-k Qungw, C A. 9225:4
INDI :1.1 "U S CA 92210
r
(160)34.5.2.376 CBLO 6697
+
i
USE OF PERMIT
?BOOL PN-DIOR SPA•
POCIMPtt,,.At,. sJ MLJ..SA.RRI.I? 'cS'S}i,,PI; . HE 1'N PLAC E A' T PR.& PL,AiSTAIM
INSPECT1014. lid WDEU
POOL A;i D/0R SPA Lu-,
6i�.ld..d..N11A3,I1> CO.In' O.L' i,ildNRi.id4J6o- OI
. Y 94K'WeYi6
�l ie91 3?]FR StIb�ii „�'RY
PLAN CHECK PE1? $105.10 .
CONSTRUCTION F1~'V '101-000-419.0Cti?
ItiA HAN.IVIAL 7 B -= PO011 101.006-+21.000 $24,009
ELF,CT,'Ri4 AL FE - FOOL 141-000.1120-000 $4S;itt3
Ia1.YlMB1110 PER- POOL 101-floo-41.19.000 $27.00
;1 •
PUAR(MCK
$361.30
PRFI.13 L�ii
z1" SAL STs' ' 111' 1 N InY'.i"�;1'�[C3 Y,
n�,3t3
9 �/j
JAY o 120011' 4
OF LA4UlhlTA �`•..
FINARdCE DEPT. y
,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
Set Backs
Steel
Electric Bond
POOLS - SPAS
Footings
Main Drain
_
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
f
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 Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
`
6 — -
CITY OF LA QUINTA SUS -CONTRACTOR IST
JOB ADDRESS %Oc� %1 � M'9 UCfJ"PERMIT NUMBER OWNER C'H 1'4— � E)L BUILDER l/lE/r1/3R��� �b�� F ��_ A' -
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous glace. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a.stoppage of work and/or the voidance
of hiiilriino nermit. For each annficahlp traria all infnrmatinn rpnupstpri hpinw miist he comnlptprl by annlicant ,fin Filp" is not an arcentable response.
A
t"
Trade /Classification
Contractor
State Contractor's License
Workers Compensation Insurance
City Business
License
•
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. iDate
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
(C-12)
-3EARTHWORK
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bwjofA
Q 71
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CONCRETE (C 8)
C
to
`t 3� 1
S 3 1317
/ O
/
FRAMING (C-5)
- J
0'
STRUCT. STEEL (C-51)
9S, DO'Z-%r7
6i o.
0& f
MASONRY (C-29)
PLUMBING (C-36)
-' '
by o a
0(0'71'7-'
�% 0
LATH, PLASTER (C-35)
/
DRYWALL (C-9)
HVAC (C-20)
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of 0
J
ELECTRICAL (C-10)
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1'�
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till/
S(i ii/1(%�
Cj�Qp2 �7
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15).
GLAZING (C-17)
,
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
,
CERAMIC TILE (C-54)
CABINETS (C-6)
-
FENCING (C-13) -
D� % b011
LANDSCAPING (C-27)
�ii� �'S( /i�:: (
POOL (C -53)C
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L(`d� •>+ �:��
S�t!�'i L
0Ql �%30
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CHILDERS
SPA +18 WITH STACKED
QUARTZITE SPILLWAY
* NOTE SET BOND BEAM\
SIX JETS
,•
3'-6" R
fi
.
4-1/2 BELOW MUD SILL
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P/
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RAISED DECK
RBB +6" -:
• +12"
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WITH THREE
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TANNING LEDGE
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WITH UMBRELLA;_
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EMBRAND
POOLS & SPAS INC
CA. LIC. 800680 C-53
78-910 VIA VENTANA -
TE (760) 1-212153
FAX (760) 771-2181
POOL & SPA SPECS
POOL SIZE: 55' X 19'
POOL AREA: 685 SF
POOL PER: 133 F
POOL DEPTH: TV TO '
SDIAMETER
SPA AREA: 38 SF
SPA PER: 21 FT
DECK AREA: 602SF
COLOR/FINISH: OWNER.TO CHOOSE
PUMP: 2 HP
FILTER, 400 SF
HEATER: 400K BTU '
,CONTROL: JANDY RS 4
CHLOR: A UARITE
NAVIGATOR
NAVI
CLEANER. G
PEBBLE: SANDY BEACH
TILE: GROUP 1-3
POOL LIGHT: 3-400 W
SPA LIGHT: 1-100 W
RBB: +6" AS PER PLAN :
MISC: THREE AERATORS
IN 6" RAISED BOND BEAM
ALLISON & ADAM CHILDERS
ADDRESS: 78-915 VIA VENTANA
CITY: LA OUINTA
0
DATE:
SCALE: 1 "=8'
RAW BY: DALLAS -
JOB