0009-119 (RPL)LICENSED CONTRACTOR DECLARATION t
I herehwaffirm under penalty of perjury that I am licensed under provisions of
-Chapte'i�*:1 (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
574127 A 08131/2(
Date-'-/-? P, o Signature of Contractor 17f'''C-
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 ro ert dam exclusive) contracting with licensed
( ) P P Y. Y 9
contractors to construct the project (Sec. 7044, Business & Professionals
Codo).
O . I am.exempt urrider Section B&P.C. for his reason
Date' f 7- Signature of Owner,. c_' .w. -e—
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty •of perjury one of the following declarations:
—(-).J.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:
Cartier $TATE FUND Policy No. 04b-Qf1-00(;79
(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: 4 /z f - ' Applicant ./� : .: e
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and • restrictions set forth on his
application.
1. Each person' upon whose behalf this application is made & each person at
Whose request and for'whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby. authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) - ~��f'`"'" +'��.--Date
PERMIT#
BUILDING PERMIT
DATE VALUATION LOT (187113-1.9 TRACT
rZ f B�
JOB SITE! (i
APN
ADDRESS �9-QfaAi.
OW�gN,EqqR
CONTRACTOR DESIGNER EN61NEEER
1V.l7iV,. Vn.l"8�,llyd'E 8`��
STEVE JODSON C014M1CT7 tl yyC
.
79.365'Vff-AVERDE
73011 C(Ji7IdTRYC,.LUDDRe MWE- 14
L.,kQ 71�3"I°A CA 92253
PAL1,At3E. .T CA 92260
(760)346-4032 r_BMi 1044
USE OF PERMIT
P00L ANIXOR SPA
_
.POOL dt SPA. UNLY'-ALii[Z3`d SibA,016WI NriKU, BE IN PL AC:E.fsT PU
ER INSPECTION.P001. EQ13.iPMP-NT ?-24CLC)SURF ISN. OT 114C?LUDE .
IV THIS PVTtMTT ;
POOL AND/OR SPA x2;350.00 LS.
En1n77-I-ID ('110ST OF +COPTISITdTJ+ETrlo.I'd
•P$,9.RMff IME b't.TKt9 ARY
PLAN CHECK FEE 101-000-439-318 $152110
CO:P3STRUC s iON FE -E 1, 01.000-418.000 $234.04
MECHANICAL FEZ -- POOL 101.000.421.000 $24,00
ELFXTRIC'.AL PEP, -, POOL _ 101-000-420-000 $45.00
PLUMBINO EBF, -- POM, 101-000-419.000 $27.00
.�
F S UB -TO A , CG NSTRUCM01$ AND PLAN CT -W=
T482.10
IMI S PPXI.1 AJD M.
$0.00
TOTAL ISfff'FEES DIVEBOW
9182.10
L
fykd
ECEIPT DATE-) j ; BY ( DXTTE FINALED INSPECTOR
a
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
4 BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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
Steel
POOLS - SPAS
Set Backs
Footings
Electric Bond
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
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��
a!
10%
Gas Test
Appliances
Final
Q
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:
RAESED MN I) BI-A\t CR(]65SF-C: no^: - - aYLdpE1O r...wa. s;,walkc- �i3mwaxs-cmum kE_
. ' « 1'-T. x 3We OL'rSIIX EDGE"FINISH r arc law.<-frees_ fences_ rel3Jliflp ----. _--
.. 'WA-[M.VROr'F Iw�vOGL�I AREA 36C PERIMETER _ DFflJ�T'i wall. gnrmkers Lelvnhgne lines or tiYl/>fs _- - se_ —
S•SHAPEOMALL BY SDC • 24" BLOCK - ._ When access s made fhr ugh a neinhhnr'& OtYIkL 3' xs' —.. N .
WALL TO Be —' _ wv,ertv ' is Lmdem aqd thaL xau Lhe owner n�H E eaP.) cq sr _ m
�ONSTREICTEDBY, ,r�+L+L - _ ADI PIPE havethat nrighboes permissionandass,m�yd1 66.-----.. ---
r _Bites. I i
OTHERS _ r o �.= � CORNG .ca�rn�EVER _ N
c�TrE ` DATE _-- signature POOL CAPACll1__u920..(d{ m
M- r FURP CAPA D
LA ML-DSILL CROSSECTION r MOTOR HPTA POKES _ STA RRE HP IS 61
FILTER . STA RITE 300 _ SQF'f N
dH?USE » FILTER.RATE' t02 'GPM W,
t .
MCD SILL HEATER LAARS. _SIZE ?0 M N
'FENCE AND
- Y
GATE BY Pti DEcw - LRNWER---- 4
WATERFALL e SL'CPON LIVES r 3
0-WNER , `� J Z- BELOW IICDSII_L - ....
DESER7 GOLD
• _ _ - - • BOULDERS NOT... -RETURN LYES ,
TO EXCEED 36" -... _- SKIMMER ROCIEL 6A1ERICAV _ _ ti
CHECKYALYE_ YES _ O
/. f ♦ R4'-1- R51.0- RS-0-+• io'• GASLINE BY SDC_- FT. lf0 N
• PATIO COYER • + '� - r POOL LIGHT 400 W CLOCK TUNR O
YON\ER tv'_II' �• 5' ► .� ELECTRICALBY,-- SDC =-30' Z
.DECK - . !TQittelflR- T
Y SDC _ - ' S-MIP FORM FINISH STUCCO O
SLEEVE PLANTERS ' -'. '. y�• - TOMATCH ROUSE PLA$R C8t42R--MK—WE
A A P" . 18' CK-BY— SDC ' SQ foe
N FEE, Q IEE MTius AREA . T v' DECK TYPE SALT 'CIA Tas _—
Il111 BE CHARGED IF THE APPROVED RT -0• _ _ SPEC
$ ` WATERFALL CROSSECTION (no to scale) - --
� SPA SPECS._.
PLANS AND 10B-CARD �N... "'� - € °' Y' "°��' y DESIGNER 92E r01� RAISED .i811-
r- kir ,.. UTE '1OD WATTS
f THE SITE FOR A SCHEDULED. basin. _ RANDYMA IN LEVEL SEATS 22-24.27"
R7'-6+ 3'_p- DAMWALL QUARTZRE'--
I. - DATE
'N �, n 3'. I DAN'NAILTOP�UARTZIIE
1KLGi _ c • 1 - i ma&m .
. '�3C' SPILLWAYQUARTDTE _
T I ? REv[SED SPILLIYAY.]OF-9QEN..
grade _� #JETS f UPPER _L -„
r pool m
s.
water 4'"0« Marne*NDREYF!_OLO:IAWHITNEY_,__ W.
• '] J' " " • ' +- ' AIlD4011rl1BFALL � .
• - - .�. ;PJL: •• Aferga� 79-36d VISTA VERDE '- r
NTA - +^ 0
OD
IC-31 TY O F LA'O I til F SONR:ISAID
-_ _ In
I
` ;JILDING &. SAFETY CcI't�uyRE
�`�i•.wD =
pq\1. �'�( W N7DE o-.s�w i SO/I
• .I ..� APPO tl�rc1F�.0 nA� ,- 3 SIA DAIN }
�-f„' WALL ' •�00ISSEPMArE
fi•
t ♦ • ` +' ADD YE\T RF377RN
FOR CONSTR�JCTIL�.,` STACK �"`F"n" PALM DESERT' _ TEMECULA„ 1
CHTICX VALV
• - - TO HEATER 73-011 COUNTRY} 28510 RANCHO '
_ CLUB OR. STE F-4 CALIFORNIA RD. • T
1!8'=1' SCALE STF 703
•!�T�� I'� • . + - - - _ PALft OE$R7 CA.
' DATE �v B Y BOBCAT _ �jAEjOpIj S s _ NOTE: LANDSCAPE AND FURNITURE 42260 99Eo ACA m
ACCESS '"�V� ARE SHOWN FOR ILLUSTRATION Uliol3S6_9032 N
RJR BLOCK WALL .E,A [�iG A:\D REPLACE'
ONLY AND ARE NOT INCLUDED_ (9Dg1626-sun►I