0010-245 (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
4127/
!
Date"!* �'' '�� GAignature of Contractor i T - 7�0-
OWNER -BUILDER DECLARATION
I hereby affirm. under penalty 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:
( ) .1 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 worker's' 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.
STP
(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 66 Labor
Code, I shall forthwith comply w,itlr�those provisions..
Dater 6' /'4, i° fy j' Applicant,
Warning: Fare to secure Workers' Compensation coverage i& unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, iri
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 pursuantto
any permit issued -as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La QuintIa, its officers, agents,.and employees.
2. Any permit issued as a result of this application becomes null and void if
i 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 ao the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. '
,Signature (Owner/Agent)/« "`f---- Datef
BUILDING PERMIT PERMTJI
DATE VALUATION LOT��_ TRACT
JOB SITE
APN
ADDRESS
'/
p�� u pE� y y p . atry�y�S
Vl a/ ,2WI VI.6.�O.1%fALr. r i.✓i.J�4JiA..A
'
OWNER
CONTRACTOR / DESIGNER / EN (NEER
s ,
_..J.�.Rl.pYii. A•i��A�iR +•b,M.7.
}}�,j�r•%J'�$$��j yy__'''f'f ,j���,'7j �i f�'�n��''''jj
j [��((� }�,/�T�y �} j' [� 7/ f •('�'�/�
Oiw�CiL:r, F'.j•.l,.Yl✓DSO'1iY CO G}�.ri�/L���n��T INC.: _
LA C.A.91,8253
PALM DMET CA 92260
(160)1.46-4-032 C } 1,4 1(W1
?
I
USE OF PERMIT
i
POOL dt SI"A, ONLY -ALA. YHA- RYStW, .r BE 1114 PLAC,I• All PRE
PIAMS i'.841 INSP, COOL EQUIP KHMOSURE Irl NOT YNCLUDED
1NV&-5Th0A`1'10H F6rU: P9n 107 U.,A.C.•. §304.5FOR WORK nou '4irx) Fe-(.ima' a
P=OEM. KNDIOR 9PA LS
,i"%&N CHECK H1
C011b"'T.4 UC: ION ME 201-000-419.000
MERC .A2'dtCAL FIRE M POOL 101-000.421.000 MOO
iSt d 0'f .1C°1'�i. SEE — POOL' 101
PLUA4,81110 YRF;- Pool, 11 01, -000-419-000 W.00
FFF, 101-t 00-423,000 $3i9.Ofi
t; R F1
xf
�110.
` 11 ]C�.L PE111MIr T 11"MrS DUE K0%,.
M91iS
OCT: 2 6 2000
RECEIPT—— ... • •,--- • • •
DATE "' '
B,Y,'` e��
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
,
Drywall - Int. Lath
Final
Final 1,
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
{
Underground Electric
Underground Plbg. Test
-�—h—
Final
Gas Piping
�
PLUMBING APPROVALS r
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
t1
ZIs`q(0�
J l`
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)
6' BENCH -18" WIDE � �
— RS' -o"
/
5"
EXISTING PLANTER AREA 3'-9"
EXISTING PLASTIC BOARD R4'-0"
W +18"
+18"/�
-
t.. P ❑
7' RS' -0"
�
8'-7"
y
P/I.
R3 -6f
+18"DATE �
+1N
-
+6N
13'-2" /
.
3 F 6 �� �`• ./
LUN I KA(, cannot assume Lespon ibili j/ for
damage to curbs, sidewalks- driveways, cement
EXISTING PLANTER AREA IS��, sewers. lawns,trees, fences, r ainina
EXISTING PLASTIC BOARD walls. sprinklers, telephone lines or shrubs
When access is made through_ a neighbor's
STRIP FORMS FOR FINISH er-ty it is understood that you, the owner,
STUCCO TO MATCH HOUSE have that neighbor's permiSSinn and assume fill
responsibility.
% ----- signature
, 1
R5'-0" !
t - WATERFALL CROSSECTION (no scale)
GENERAL SPECIFICATIONS
SIZE 18 X 31
I
AREA 347 PERIMETER
87
DEPTH 3X7
TURNOVER 3.4 HRS
TILE CHOICE GROUP 3 SQ.
55
RBB. 30' AT 18 "
Irwpry \/Al vG YES
COPING CANTILEVER
POOL CAPACITY 20925
,ALS
PUMP CAPACITY . 10-'•
GPM
MOTOR HP STA RITE
1.5
ADD EXTRA
POOL -SWEEP
PORT
MOTOR HP STA RITE
HP 3/4
FILTER STA RITE 300
$ Q FF
6' BENCH -18" WIDE � �
— RS' -o"
/
5"
17,-0" -1 '-10"
r R4`-0"
I
INSTALL ONE CRAB TILE
ON TOP STEP
1 8,
upbasi
. �� ti 4 ' f
�
��
,� f. S -0SKIMMERM
I
FILTER RATE . 102 GPM
HATE STA RITE IZE 400K BT
TURNOVER 3.4 HRS
SUCTION LINES 2
RETURN LINES '- "
D AIVIERICAN
Irwpry \/Al vG YES
P/