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0304-210 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of �Y 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 # Lic. Class s Exp. Date 779165 mc ,q Date '42 15-01 �'01 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 proje6t4 (Sec. 7044, Business A Professionals Code). O I am exempt under Section B&P.C. for this reason Date Signature of Owner E WORKER'S COMPENSATION DECLARATION„A;.o ' 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 the work for.which'this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier STATF 1`U11i7 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 provisionsofSection 3700 of the Labor Code, I shall forthwith comply with those.;provlslons. 'Date:.. f/-• fs Applicant- Warning: pplicant Warning: Failure to secure Workers Compensation coverage ,is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, ih 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 relatingto the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. 14, Signature (Owner/Agent)'`' Date r J� 1, BUILDING PERMIT : PERMIT# LOT � TRACT �./ a,Y�. .�„b P�,� .6LV6rlT�vV.:/t� .. _. DATE i'l PrP :VALUATION�p f ftre A •�f"4� dIG'.Y 6.� • 'JOB SITE ° APN ADDRESS II�re`� �iS%u^tiv'r OWNER CONTRACTOR/DESIGNER/EN (NEER VACS 1lMI M PARTNT't HIP CAWYON VI�,�r P{-1©ul 82.2(i4•Z�i(s�iZl1�Y 111 �faTl% �w�(�a axg5 � TA.���Eit`�ii: k'1''► niff o CA 92201 PAIN'SPR 1408 CA 922621. CDU 2951 USE OF PERMIT POOL AM`OR SPA PQ7WSPAONI;Y.• ALARMS/5ARPLI "SHALL OF. 221 PLACE AT P'RL-AJA9TE.R.INSPECTION: EQUIPMENT ENt,WS[T:ttE, NOT 1�'�t'1sUDED .' POOL AND tali. LIRA %A,Oslu;499 IS OT ),vh'lit'1'l` FEF, '1MOViARY PLAN CHECK k' K FFA 101.000-439.318 SIXiS CONS TRUC: T ION ME MEC HMICAL R8 -- POOL, 1,01'0000-421-0 00 $24,01 '. SLEC.TRIC.At. ME, . POOL 1,01-000-4.20-000 4100 "f?L13MBINO KE -- POOL, 101-000,1 19-000 $27,00 U APR.. 18 2003 CITY OF LA S UINTA: - 4Li)?T:, A14 MIECR Ivy 31.55 LIE 133 PR&J AID FIM.3 $0.00 'IT K $41374515 ..,. , RECEIPT DATEtaygd BY or D IN OR t ;I fA vv. v 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 Unes 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 FinalUlu 1 11 COMMENTS: .- %�- #L �l�t-No, sC �,��ae� i - *43 70L 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 1 Final Utility Notice (Perm) LA MONT DEVELOPMENT 56-365 Village Drive (Lot 44) La Quinta CA 92253 THE PALMS i' CONCRETE SETBACK AT 3' FROM P/L GENERAL SPECIFICATIONS i 3'0 spray head (4) DIMENSIONS: POOL SPA 4'0 Length: 32'0" 8V1 Width: 1656" '610" u Surface Area: 340 SF 48 SF 95 FT 28 FT " Perimeter: r • 8 0 . ' Depth: 3'0" to 5'0" 42" MAX -• - a ,p001 Demo: ,32'0 Concrete: N/A +12--4- 1 - 3' TILED SPILLWAY 6'p"__" r Sod /Gravel: N/A25'9 16'5 Plumbing: Jc' 3' 2"r 19101— Extra Spa to Equipment: N/A T9 STUCCO EXTERIOR TO Raised Spa Bypass w/ck value: YES \MATCH HOUSE Dedicated Vac Line: NOh V benc6'0 SPA SET @ +18" 4'0 Gas Line Extra: 150 LF { A Gas Line for BBQ/Fire Pit: N/A FIVE BACK JETS Spa Jets: ecki g Decking: y z STEPS 80 ,. rd . n . ,r Color w/salt finish:' 964 SF DECKING, CAP @ RAISED SPA Cantilever Edge: 123 LF _ bobcat access G 3" Deck Drains (per LF): N/A I Step Riser (per LF): N/A P/L dar Dam Wall: +18" Raised Bond Beam: 33 LF @ +12", TILE FACE — — — --- — — — tS-ri Umbrella Sleeve: N/A TRE LIS P/L L existing wall Tile/Stone: Basic Tile Group: 123 LF 6" GROUP 1 OR 2 TILE ❑H Quartzite 6" Waterline: N/A light switch Step Trim: N/A F-5'0 Tile Raised Areas: 30 SF @ DAM WALL, 6 FT TILE SPILLWAY C7/E planter O planter h Masonry: Spillway: 6 FT GROUP 1 OR 2 TILE _„ maintain 4' from exterior al planters i w to eat Waterfall: N/A sleeve I pl t s w`ndo h er • - sleeve all planters _ BBQ: N/A I GAT Firepit: N/A E Boulders: N/A -Access Wall: N/A LOT 44 @THE PALMS APPROVED BY CONSTRUCTION SUPERINTENDANT Equipment Wall: N/A Paint/Stucco/Plaster: STUCCO @ RAISED SPA EXT & RBB BACKSIDE DATE- . _ Pool Finish: ' r . White Pool Plaster: YES Pebble Pool: N/A • ' .: _. - APPROVED BY DESIGNER & SALESPER SON Equipment: Pump: HAYWARD NORTHSTAR 1.5 HP CIRC/SPA : _ Pump: HAYWARD NORTHSTAR 1.0 WATER FEATURE = ti,•; CITY i OF LA QUINTA DATE Filter: HAYWARD 400 SF CARTRIDGE -TYPE r. ; ✓ f BUILDING & SAFELY DEPT. Heater: HAYWARD 400k BTU LO-NOX , T c � APPROVED Controller: STANDARD TIME CLOCK, .APPROVED BY CUSTOMER Hayward Navigator: N/A - FOR CONSTRUCT Pool Light: ONE 400 -WATT j h43 r Spa Light: ONE 100 -WATT ' OA DATE Purification System: N/A s Z _ Water Feature: FOUR "SCUPPERS" ON RBB PER PLAN ` . ` Landscape: N/A t Patio Cover: N/A , Fencing' N/A "MISC. SPECIFICATIONS: ALARMS & SPRINGS PER CITY CODE 760-778-2700 760-320-3667 FAX 2295 East Tamarisk Road Palin Springs, CA 92262 License NO. 779165 Buyer is aware that oral representation or expression by either party is not binding unless detailed and signed by buyer and seller.