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0010-070 (RPL)LICENSED CONTRACTOR DECLARATION I hgeby af�kn under penalty of, perjury that I -am licensed under provisions of Chapter 9 (commencing with Section ' 7000) of Division 3 of the Business and Pr6fessionals'Code, and my License is in full force and effect. License # Lic. Class Exp. Date e- Datc"t 2151110 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: 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)'. 1, as owner of the property, ern exclusively contracting with licensed contractors to construct the project (Sec-.' 7044, Business & Prof egsio'nals Code). O I am exempt under Section B&P * C ' f _thls,reasoz� Date/ —Signature of Owner,,�_ WORKER'S COMPENSATION DECLARATION 11 hereby affirm under penalty of perjury one of * the following, declarations: — f 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 thid permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. STATEMW (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 nner 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 forltbwith comply witt;*t!.�5&rovisione \I, Date:. ar `q C� Applicants 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!6 the cost of compensation, damages I as provided for in Section on 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made� to. the Director o . f . Building and nd Safety, f 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 *td. 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 subje6t 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 orize representatives of this City to enter, upon;:, oned prop erty forinspection pup the aboVe-menti oses. V Signature (Owner/A gerf6)Z' I. C—-; -Date Q1 13 . UILDING . PERMIT PERMIT# DATE VALUATION LOT .41170 TRACT JOB SITE APN ADDRESS 145 WARMFIELT) CIRME OWNER CONTRACTOR/DESIGNER/ Mf M CAUMEM-*1 C' '6TRUMON 'INC. MINEDODW. ON 1A Qui&FA CA. 92251 PAIM INMRT CA. 92260 (760).34,6-4032 (TTYU 10441 USE OF PERMIT Pt 4M RMUOR SPA M, X &.3PA r7.N1X'..ALAJ2hfiMAPR1ERS SHALL HE IN PLACE'ATPte' ENCLOSURE -M NOT NCLuDo 11.4 "'HIS PMMIT NO 01, A 14 D A-) R 0 FA 17100.0 W PNRWIMAFYSTWATTT) C*OTOF CONWRUM0J f FMEMMR. PIAN CHECK PIM 10).000-4359-3 18 CONSTRUCT1014KE 101-1000418-000 Wr)HAHICAL FRE EL1.0TRICAL P MIX .. POOL .101-000-420-000 Ilim, _ POOL 101-'000-419-000 SW�-TarAl, MUTC.TION AND MAN 04WX LEW PRER-PAUDMIL TMAL PERWIMS DVE now OCT 2 0.2000 S4011111 $0.00 $40725 , 11 %AN _44 r"• - I — RECEIPT DATEBY DATE FINALED INSPECTOR L INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS, Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test 3� Final Gas Piping C —� 1 PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection EncapsulationZZ f�O Gas Piping(xJ� Gas Test Appliances Final r2�(,9�ce COMMENTS: Final Utility Notice (Gas) - ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) h .r1r val!r d we,!!S�CCt!,ttpC - - 242CitS!'AUES SIZE 12.6" X ]b • . .. ._. DIV ___.—_• •l�rwnw-2�r�/gnrCS�[E .. —_ — .,-4R!T'E KLIL TO \1;�14IIZE WALL HEIG1iT - .SG�kICr� telrnhone f nac or s.��i!.g ASA. _?84_ PER!NEI ER 81 . P.R_ 1FOta! accec i 'rt - tMo. d� a neiahho�s DEPTH T ] X 5 O �syipeA CocO=x hn ��^�^ntaod drat yon th ar 3n Z T& _QlQGGt'P�i x..68 — n • /� 4'6" _ 4'f" �._� d - have that naofi6er'4 perms on a dam it !! - - - CU?R_JO_CAN-EILEVER _ A ✓< -0' onset DATE ___ A F - signatureY POOL CAPACi 1r_-..-- IL400 GA.L$_- 01 LAOLTYI'A BONES P QW CAPA�iTY _ 102 GEM 0 . {�` jI OR HP_STA RETE ' 9 c Nla►su t sErrinv FUI OR HP_-----•---- - ' m u, ! J J _ --- -- - --- 19'-6^ — Y FILTER STA 300 A _ _ BOUSE — - — — — — — , oR EfLLfl3 BALE ._ ... ? 02 GPM N NOTE TO>]EC'IC►L>�i -6 T — xeD SILL NEATER LA9ftS i1ZE ;_oaos SEE OWNER FOR SCORING PATTERN —� 12' ' — - * .HRS BEFORE FINISH -. t`••8 r - DECK TIAiNOygR 3ti",704tS' _ nrtsetJ+.O' e_6- ♦ - 2'BELOWIiI'If6[LL SiliiQiV.L�N[S— '-- -- _- 3 SQGARE PATTER` i _ l2'A • 18' onset NOTE 2 SPILLWAYS BACKHOE " --_-- --- --• _ RETURN LRJES -_ .. =- - BEFORE SALTING S 2 • - ... — 14•-8• ACCESS ... —..-- SI MMER MOOEL. AMERICA\ t7 —SCORING PATTERN' � .- — ' - NO WALLS CHEM VALVE. YES- _-..—..-- C - P/L FtA <- - _ VET I GASUNE BY SDC_—f_T_60_ O '. SLEEVEFLANTERS - P/L - POOLLIGH'1400 W CLOCK T104R Z ADD VENT TiA - - ELECTRICAL BY. SDC_ FL 200. . STACK - A�QCL.EAN�'R__-----------TO TO. HEATER - G;E_ - CHEW.F.EEDER__-- O 'UTE SWITCH ITCH TO OLTSIDE }. - PLA—SJER_QOLQ; WHITE r OF DOOR TO BACKYARD - DECK By MASTER - OECKTYPE SALT FINISH_TW Y BEDROOM _ STEP CONC FT- �•-0•• SPA SPECS. - - RESIDENCE DFSIGNFR 512E RALg� ♦II= r UTE 100 WATTS BANDY. RI LEVEL SEATS 2Z' 24" 2T DATE DAMWALL 6 " % 9 FT- — 1 - - T Li -00 DAMwALL 70P TILED . _ ,. SRLLWAY97E 3_7f IS W®E ' ^ - REVISED SPIUWA. xr N �('I�OSan m " • _ �`1{ni _) v.H11LN�ll�U""�� _ cuNTGRYH OMESIXALDW LLZelD`r80dIess:78775 -,C 1NTALA QLW IBAU 6EAR8£LLA 2 jj1Ig 15 N CITY OF LA QUI NTA N i RE -'INSPECT 'fEf Of $30 Y PODIS ' - BUILDING & SAFETY DEPT. ! ARE 1 _ PALM DESERT TEMECUfA ® WILL BE CHARGED if SNE APPRdVE© 73-017 cOIa4TRY /'1 P i� ®�7 ® RD ARE NOj ON 2x920 RANCHO $TANS AND 106 _ l/8"=I• SCALE CLUB DR. STE F-4 CALIFORNIA -RD. ' SCREDUl r� : LANDSCAPE AND FURM'rURE 92260 PALM SERT Ca, sTE 203 m ,If1 TEWClAA CA. T RU CTI O N THE SITE FOR AM SHOWN FOR ILLUSTRATION [�O)a46-403 92590 N Fog ONLY AND ARE NOT LNCLUDED. i99q)67.5:iwm 4 , DATE ►rySpECitO �� - " • O v" BY