0403-307 (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
3012919 C-53 IMC 1131106
Date Signature offContractor
•
414� OWNER -BUILDER DE%,KRATION,
I hereby affirm underpenalty of perjury that 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
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 isissytd.My;,��orkers' compensation insurance craerp9licy no. are:
Carrier 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
Warning:,,Failure to secure Workers' Compensation coverage is unlawful and
Shall subject-aan employer to criminalpenalties an&civil,fihes 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.
S;
I Signature (Owner/Agent) Date
f
r = BUILDING PERMIT PERMIT#
DATE VALUATION,{iCs' w�. LOT \ TRACT
JOBSITE si5! �%T °moi a I s ai as APN',, _.
ADDRESS..
OWNER CONTRACTOR/DESIGNER/EN (NEER
OW -17011:1 HUM ON a P�''�Iid� €�C)C)t ;i �a: ►31�
49-2*0 VWrA WR 01., P. Ca. BOX *10641
L. k e"0I fA Qk 92253 P�M T3.%:M- T Oso. 9225.51
(766513:$2.7665 CBL4r 3352
IUSE,
irS,; 0WD%0.7 _
SHALL BE IN f7LACE Ixt OIR.TJ:PREPL AS'T2R D4-3P.-RCVA *mT,
POOL A;ND1t3I1:::i'A AuMOO W
FSI" AigA: FD COVT OF C'O.I STWUMOR
40,009.0Tl.
YWRAWRI'i'19 SUMMARY
PIM MirlI0K FEE
101--{ O-439-315
CONlS' R.Uf.;TIONi FES,
I41%-1000-419_000
�??cr3tA1IG,�aI,M
iCli�ZtfO�U11�C00
-
Mz&C1ANICAL F2 - POOL
'101-000-421-000
BLECTRIC AI. FE -1; - P0014
101.000-W-000
S45.00
PL.U'M UD110 FE - POOL '
103-0010-419-00T
"$27.00
U `MAI, 4 +`S'CI`t C.°t 4>Af ANI-) P -LAX 6:21FC":
MISS PR1?,-rJA1D P103
Q,
)'
MAR 22 2004
CITY OF LA QUINTA
FINANCE DEP
RECEIPTDATE BY DATE FINALED INSPECTO
j?;,_kc.
16172168
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel r b v4
Set Backs
Electric Bond cA
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
OX for Finish Plaster
Sewer Lateral
Pool Cover Aef—
Sewer Connection
Encapsulation — —
Gas Piping
,
Gas Test
Appliances
Final
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)
NOTE:ALL WULDERS
:•
ONEY GOLD QUARTZITE
o �
11 Ii iii
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till
• BRASS DECK DRAINS
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MEMNON
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.-
AZURE
POOLS & SPAS
P.0 BOX 10641 .
PALM DESERT, 92255'-
.(760)
2255`,(760) 322-7665
LIC# C-53, 802919
POOL & SPA SPECS-
POOL
PECSPOOL SIZE: 22' X 40'
POOL AREA: 720 SF
POOL 4 FT
POOL DEPTH: 3'X*S'-
P SI • 8'6"
SPA AREA: 57 SF
PA PER: 27
S .•
DECK AREA: 1,759 SF -
COLOR: WESTERN GOLD
PUMP: PENTAIR WHISPER FLO
FILTER: E T DGE
HEATER: 400K BTU
CONTROL: JANDY RS 4 '
CHLOR:.
CLEANER:
PEBBLE: TAHOE BLUE
WATERLINE: SLATE
POOL LIGHT: 3-400 W
SPA LIGHT: 1-10.0 W
RBB:
MISC. ALL BOULDERS ARE
HONEY GOLD QUARTZITE'-!.
SPA SEATING 22" 24" 27"
HUSTON: RESIDENCE
ADDRESS: 49-350 VISTA MARISOL.
CITY: LA OUINTA
LOT 31 111.0
DATE: j
SCALE: 1 "=8'
DRAWN BY:
JOB
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