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9704-052 (RPL)LICENSED CONTRACTOR DECLARATION I hpreby 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 514127 A 1&1 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 perf?Irmance 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 "AlU F1;'rfiJ Policy No. 17AW9.96 (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 forthwith comply with those provisions? '``Date�'//i' ? Applicant V.,e/,,- Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at' whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned propertyffor inspection purposes W. 'Signatureice" Date I DATE JOB SITE ADDRESS IOWNER BUILDING PERMIT 41.1014)7VALUATION S14,f)00.()t► LOT 79`140 VIOLET Chi D OLI 03 t,AS S,II r1 i.l',S 79-2401t1OLM' 10f . (AQUINT-A. . USE OF PERMIT PERMIT # CONTROL # '7{ 052 4973 TRACT APN CONTRACTOR/DESIGNER/ENGINEER Ftp1 P ODSION CON M ijr- Rom 73-01.1 COUNTRY CLUB DRYVE', SIT, F4 CA 92253: PALM . FS:11tT CA 92260 (760l3464)32 CALff 1044 14,900.0; LS QED C_f�vr� OF �.'' N11-�"rR1JC r10._1'N �4,9"�f3.il1T j�■��' a�'!'iNIi KLAN (-` llt'C K f?EK- 101-000»439-31$ fit0 ?t3 C01t4 i'!'FWC,"f CJ q 1114s 1014VO-4113-111)0 EN&CDMNl<"X,FEE ...,f 7L 10.1-000-421.000.*24.00 9J.1w+:;iit ICiVL MW •--11001,, 101-000-420-000 W,00 P.l.tfly "JNkf IEEE -- POOL X01 -060f ,i I9 -0©o 527,00 131OTAL CONti'R ON AND FLAN CH CK$36330 1) Fr LS �7ES .APR 141997 '1<'OTAL, P1FI2it9IT F- US DTIC NOW OF LA. 0. UINTA �t:f RECEIPT DATE f 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 - SP S 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 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: ' CONTRACTOR cannot assume responsibilityfor GE\ERAL SPECIFICATIONS damage to curbs, sidewalks, driveways. cement ` slabs, sewers, lawns.trees. fences, refaining SIZE 14 x 28 - walls sprinklers telephone lines or shrubs AREA 335 PERIMETER When access is made through a neighbor'sDEPTH 3' 6"X5' .t _ property it is understood that you, the owner, TILE CHOICE T.B.S. S 85 have that neighbor's permission and assume full RBB +.6''=23'/+1 2"=1 0'.. responsibility: - -COPING ROCK/CANT DATE _ PI signature POOL CAPACITY GALS ANDSCAPE ROCKS PUMP CAPACITY GPM air Line . _ APROX 24" DIA MOTOR HP STA RITE. Hpl .5 MOTOR HP HP , box t PER PLAN ` FILTER STA RITE 300 SQ FT +14" FILTER RATE 3 GPM - spa +12" 6' HEATER LAARS SIZE _25.0 BTU 3 .typ raised b + • TURNOVER 'HRS Spa 7'x7' flag SUCTION LINES 2 �' tYP RETURN LINF-S - f SKIMMER MODEL AM_ ALvE YES PI +1 6.� . ecw�� GASLINE BY S.d.C. FT. 42 - +181 pl POOL LIGHT 400 CLOCK 28,4, } ELECTRICAL BY. S.D.C. 1 12 . AUTO F 12' 'L �, „ NO 3' tYP CHEM. FEEDERRNO 148 - PLASTER COLOR WHITE - } DECK BY S.D.C. SQ. 514 I typ STEP. ' FT. , _T7 / SPA SPECS. „ 4'P / SIZE 7 RAISED +'12" - 1 4 �- 3' -g,, LITE i WATTS 100 1 RI LEVEL SEATS 22" 24" 27" 1215.1" DAMWALL X FT." a DAMWALL TOP. the - DESIGNER ` a SPILLWAY SIZE "' X "" WIDE jarnie SPILLWAY OPEN CLOSED r ---light SWItch :I DATE #.JETS 4 UPER LOWER +4 -25-97 j box A Name: DOUG. SHEETS - - - Address: 79-240 VIOLETT-CT 250 ' I F LA Ulf c Iq DEL REY LOT* 34 ` +18,• BUILDING � SAF[ DEPARTMENT CONDMIDULLY 009 . 'M LI i 7I . P41614F - RSTEREOPY PALM DESERT TEMECULA 73-01 1 COUNTRY -28910 RANCHO t „_ , „ . CLUB DR. STE F-4 CALIFORNIA. RD. C�Lb scale: 1/8 -1 0 PALM DESERT CA. - STE 206 - TEMECULA CA. LANDSCAPE AND FUR TIT URE 92260 s25so . -- ARE SHOWN FOR ILLUSTRATION. (619) 346-4032. (909)676 -SWIM 0 "LY AND ARE NOT INCLUDED. LIC # A-574127.