0403-352 (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 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
C:s3 Fn c bf 3 i
Date 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
perffgL(nance 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.
STATE C:C��i:��''ENIAT! 0464168-2004
(This section, need not -be completed if the permit valuation is for $100.00 or less).
() I certify that in, 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' compensationfprovisions of Section 3700 of the Labor;
Code, Irshall Dortwith comply with those 6rovislons yq
Date: �' ✓ %'� `� Applicant—
Warning:
a
Warning: Failure to secure Workers' Compensation coverage 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 per 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
ir
e representatives of this City to enter upon
construction, and hereby,, autivoci
the above-mentioned property for`Inspection,purp�osed..
/a�V
Signature (Owner/Agent);-. , Date
PERMIT #
} =BUILDING PERMIT_
e
DATE VALUATION "=-'- • LOT ,.�,�,, TRACT
JOB SITE
ADDRESS
APN
56-5-115 VMLAGY. DRIVE
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MkIDW,RO11 I :S
CAiffC����1'�fAPOOLS & STIAS -1-1 MM Cai
W.•
5 X CITRW keV._ �9-M 205
86.100 .AVENUE 541
:i2;4{.�'iLeL�3` S C.A.92373
C;C?.��C:'t ! ! s (: 922116
(76,0)398.9222 ',^.J3 , 00M
USE OF PERMIT
POOL ANDIOR PA
1001, a_ SPA. .613Q A14SI 721.58-21995. ,Al:/1RAS 5AiZR1FX,,S SHAIJ, SE
10 11,AC.X F'Rdir k TCS P1UPL XTER IN PEC TIC>N,
POOL AND.I.O}i k AL l ,400.00 ISS
1 01-FIA's AITCD C:OI.r OF clorisrRUC310r,
18,UU wo
FeRMIA79: LIE SLf'M'MArcy
PLAN CHECK i'RIE 51=5
C 0 4'iTP4.UCTIGQ,T FELE 101-000.418-000 $19.9,00
MEClMAl;lCAL s l Z -- Po DL '101-000-421-000 $24,00
131 CTRICJAL IEEE - POOL ! 101-000.420-000 $43.00
PLUMD1140 FRE --POOL 1131.000.419.000 01,00
.: MIS PIM -PAID FRES
$0.00
mac., I M- TFs aUP. N0W
MAR 125 2004
y
' CiTy OF I�N
Tq FE
AQ�U
®6PT.
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
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
_IL
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lirrus
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Rans
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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
SPECIFICATIONS
qG
SIZE X �
_ SURFACE AREA OF POOL �
rn
! r?L.{a 2 CMI' I
c DEPTHS MIN. MAX.
PERIMETER c� cc
cc
1F
SPA SPEC:, (CATIONS TILE _a o
f' SIZE 0' X 7 SQ. FT. TILE TYPE r�
I
1 WATER UNE Q ^
- - SPA DAM WALL WIDTH
t. . r I TILE TRIM w
{_- `. ' (�I y ` 60rm-16r ,`1�'=-t 'UIN.� t{ c' Lr. , '^ N0. OF QTS y Q
r A ' l �j C l r C� QUARTER ROUND U< u}
y Y LIGHT
_ .
{ r R.B.B. F Q
�l
, ; : RAISED SPA. AT f
t Q7 `'flr ti F ! CC/ i : f , ';, T T, 5T r N O
SPILLWAY TYPE �i . ,� �G et CN z
C14 Lj
s,
j SPECIAL NOTES Qy U
! aFIG 46T67 DECKING -- cc w
SQFT
t , { ►{ ), 5ponT 64A -le -4 f- EXCAVATION STEEL FINISH o
TYPE v
U
ACCESS FROM EXPANSION JOINTS C
^ CANTILEVER
ELEVATION
DECK DRAINS CL
ti• f` �, DEEP Er,D RAMP '
t 'DECCO DRAIN _
LOVE SEAT
^..j � h1 Gi �i 1-i � L :F .4-T (m Y% •� G y CONCRETE REMOVAL LOADS
—� CURB CORE
__ __-� s �-,
l''t✓IF\,t`J !1'. 1, — .�«, STEPS _
SOD REMOVAL LOADS!,.
}-, yz r' �, ; • 5,, a-_`. , "� L i� P C,. VL� V�- � TREE REMOVAL BY STEP FACE i
IRRIGATION REMOVAL By TILE BASE }
-. i' t
-� r
�I
IRRIOA.?10H REPAIR SAND AND VISQUEEN I
a `6' RAE), ftJ RIBBONS
y-
:,%
✓" �,' I
12 R.B.B..fd MOW STRIP
8 R.B.B. It
R.9.B. I
.,. E
.. _ �. 30" R.9.9. It I
a T H DEPTH
ANS ELF DEP
a
MASONRY 1
' %j ROCK POCKETS COPING TYPE 1
r
�• ^.r ! «/ F
CENTERS �kB.B. FACING �
- y SPILLWAY TYPE SIZE
,
1tn
PLUMBING
1PROP. EXT. WALLS
RLTER SIZE
PLANTER WALL )
POCL PUMP SIZE
RETAINING WALLS j
m, BOOSTER PUMP SIZE EQUIP. WALLS
ADO'L PUMP SIZE
FIR,EPIT
1 —
ADU L PUMp SIZE I ;
C , HEATER SIZE
1
� 0 j} / ,� 1e � t
I
TIME CLOCK �
! i
SUB PANEL '
i
i-, ADO'L OUTLE
I
SKIMMER TYPE
i !
:
FILL UNE PEBBLE PLASTER i
UGHTS POOL
I
lT GAS UNE STUBS
LIGHTS SPA
1.; r
FOUNTAINS RAYHEADS ROLLED BONi BEAM _ T
SHEER DESCENTS BEHIND SPA ------
EYEBALLS. ,
L;gHTS IN POC! IN SPA
` s
✓- , 9
STUB SET EQUIPMEA.NT FENCING �
M,SC.
NCE TYPE r
PLUMBING SIZE
,-s
HEIGHT
�
GA 1 �
GTE
:
d
TP ,
TGATE
GAN. F _
r,
ELLE
�
, REMOVE � R_ A ,, .
a
R. �„R
,,£E EN, a
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I EST. COMPLETION
ANn _R}� 0 C - CLG
^ _
_ .
1
i
O TH Fr _-,
, R.B.B. -- SEE STT:EL _ _ •-, ,
J
-
4 1VIASTE.
s
FAMILY I, OWNER ,ITE
MWI
:
_.
6' ' ;
r
,
ROOM
,
, Ra ELEVATION Y N DAY Of EXCAVA7.O a
, - I,; ,N A . ,. X_MATE L.-VAnON OF POOL OR SPA A LAYOUT 0 D
I ,, • ---- ,.: OWNER To. ,i) OE'ERM E TOE P O - ,
,
5 1 i
- C
\) T
F ACCEPTA'
c T A Ate., 3 ,
I THAT P AN. EQUIPMENT LOCAP,ONS ARE SU9.;E�. 0 CCEP
, I (2, TAKE NC'}�.E POOL
10 _0 CL'C F _ _. _ n+w c T OF ISSUANCE OF PERMT
}I � ,� } LOCAL 8,,._pING DEPARTMENT A TIME SS r
- 1 C I: !S D
2 O C _ t T LEAST TWICE DAILY FOR SEVEN DAYS AFTER SHELL .o INSTALLED § t
(3, WET DOWN CONCRETE SHELL A LE r...._. --.,..a
I T v
(4) AGREE THAT CALIFORNIA POOLS IS N0, RESPONSIBLE FOR UhiD,_RGROL'ND CONDITIONS OR OO.,ECTS I `— —"•"'
I ,. EA
i
WET O , CUR SIDEWALKS, DRIVEWAYS, LAWNS, 4R OTHER ITEMS IN THE ACCs S AR
AND ANY DAMAGE TO BS,a
n, � 1
<*, I=, BJ�\ _ - T N GATES, AND GARAGE DCORS MEET LOCAL C^vDES FOR A Fv EN. LOSURE
I' �. ;
s) SEE THAT ALL FENCING, G TE
!✓ i PRIOR TO PREPLASTER INSPECTION I I r
e ' " z
O ( _ 3
6 FILL POOL IMMEDIATELY AFTER PLASTER. (FOLLOW lNSTR!JCT10N5 -- DO NOT USE RUB HOSE)
(7) TAKE NOTICE THAT THIS DRAWING t
/ 5 THE SOLE PROPERTY OF CALIFORNIA POG S AND THAT ANY -_
i
,
USE WITHOUT WRITTEN PEP -MISSION OF CALIFORNIA POOLS, INC, IS PROHIBITED BY LAW. I
I {
nWN R APPROVES PLAN POC`_AND EQUIPMENT LOCATIONS AND HAS READ THE RESPwS H',LIT1E5 AND NOTICES ABOVE.
'
1U_-
f
I� DATE
MASTER 1!
; � SIGNATURE(S)
, � )
aL i
DINING LIVING
BATH D f swIMMiNG Pool PLAN FOR:
tq }, C
I� ,,,k R(/�J(/�)�J/�\ ROOM NA
9,, .fid, 1`\Y V f ♦ , I � C,_,�._• t
I HERR RESIDENCE
'z 16' 2,, x 1 1 ' 3" 1 U Z" x 18 5' ------
71; , .; t
12 -0 CLG i 2 0 C
STREET `D_.'
};
,
I CITY r.! { ;
OB ADDRESS
L �+ C�.,
- s I PHONE OFFICE RES'{
I LOT TRACT PAGE B 0 C-) K
i
_ --- I CLOSET = t��:r�-�___...., ��-rt,�. ENTRY _�____ -- {
`f ! y
,: , _..� , MAP 80OK PAGE N0. CITY
}
I
MAIL ADDRESS
I
PWR
I I ti N TRUCTiON OFFICE PHONE N0. :_ M
„ SCALE Y ; CHECK B'
! 0 I._.-B�4TM 3 DATE DRAWN BY SOD 8 (,
k,
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I � �.-
F---
I .
t V
BATH ?_ I,I
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ke ,, , 4 '^.-..+._.,.-...,,----_•- _- _. .___._..._.. _._ ���" t�Lti...l����- V d i%� V {.. '� 1'-•'I , V'_.� Y � � _.-__-.,_ _____---._...—ELLE_._„_... a i
I I '
_ _..
CITY OF
BEDROOM LA QUINTA
1
E ? <, JB9JlLD1N
G &SAFETY DEPT: _
( i2'x1I10
L,I�
BEDROOM 2 I „
YO -0 CLG ,, ,
i ', � APPROVE®
i
I , 10 x i { II i
----FOR-EONSTRUCTION
c- ( 1 C? -0 CL'C. ? . , GUEST '
1
„
SERVICE ROOM ar�rE B
,BED
12 x i i CLEC) I
� /'�,._., ,
-- j �pOCLG r
C
- . _. _1
- �,
GU EST 0
STONE
Cc
CONSTRUCTION TH RIZATION
LIVING,- __
BATH! ,I
I
y T,�E A RE -INSPECTION FEE OF $30
i ' I SALI.S $30
SALF
14 x 14
f II
_ , �� _R WILL BE CHARGED IFTHE APPROVED
10-0 CLCD
•, it _ _ . ;, _ ._ `” _ _ . _. __ _ _ _� ELLE ,-_.
I r�l�a __ RE NOT ON —
GARAGE ! ------ PLANS AND JOB CARD A
:I 0C
Lu
DECK .,��".., , -�-
! , -A--SCHEDULED__._._ . _ _ _ � .e�....
: —�- THE SITE FOR ,
I; .
_, ZZ
J A. N D
Y
; I_NSP._E.CELLTEI_O_ _N_.l N [) th�K(���I�
t
1
NO EXCEPTIONS!°
• .r
�fi.1ONkl" 1
SIGNATURE I F P C{
t
D'" a f Cl age O r'} d 1 "" r I C� t� ? '.., t7 for r , r, � £, r C7 rl, rj
# �J
fr C
} Rf: 1 1 131 LE DRAINAGE NOTE: unless } e- ,, - no e
others, LJ ..,ss o:h, � s,v ro� .
i
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