0010-060 (RPL)LICENSED CONTRACTOR DECLARATION ^`
Lhereby arfirm under penalty of perjury that I am licensed under provisions of
d apter , ommencing 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
Date Signature of Contractor
9 % .
1 OWNER -BUILDER DECLARATION "
I hereby affirm under penalty of perjury that,l am exempt from the Contrac'tor'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).
G:';I am.exemDt under Section B&P.C. for.this,reason
�l ,away r �.�.: I �,�.a ,a' "��a .N'"'.r' ,'r" �'�.. � r"'°"•'^"-.�,�,
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 3700.6f 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:
Carrier Policy Noc ' • _
�MFR FUND
(This section need not be'completed if the permit valuation is for $100.00. or less):
O 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 1 should become
subject to the workers' compensation provisions of Section 3700 of the:Labor
Code, I shall forthwith comply with4hose pr ovlsioris.
Date: r• ,.�pApplicant.r'���"
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 perm it.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)r" Date ao� j
7� �r
BUILDING PERMIT PERMT#
DATE .VALUATION LOT ! D .��'j(j TRACT
`
JOB SITE I
APN
ADDRESS' rt �,•�Y y�y�
ai3Y`K: rYEY ��F`.7J•+i.�r3'�X.1I.J S.•1LG5,�•+0.66w
_ •• .
OWNER
CONTRACTOR/DESIGNER/EN (NEER'
r 9' ?df�'fl'C' >~+:T...
I"l+; E TDf y�}wKlei' � :C XMIlya T,ICyR MCI.
'118-8410 WAIMM LD CIRCI.,
733 't 174
1A QF iIN'.0 A r;,'% S`1' 25 3
PALM Mo bWRT CA 92260
(160):44640.32 MUf . t CK4 . .
USE OF PERMIT
I'0cig1,i�
Ar+1 PRE
aYtY�ffa°cq��y:���y'��, A�d��n}p7grtrl p p9 )n1 { n e�� PI
POOL atL kl1'�A D:il4 Av)-d'Y�„tl'1.iLaet)LiJMI.RI�.RIMER\+�'a. ii'\¢'.&I L BE IN E l.c/'t-�aE A'31 L'.sRE j • .
faTAS'6' R MIMMf'i'Jrf;i'00% C. QUIPta YK%1T YNCI.>69R RF, 0 FOOT INL(,*UDF..D
'114 THIS PFIt!'s IT
POOL AND/OR SPA 61
ESTINW20 Vogl, OF CON6112TY(MONB
� "
PUAW CHECK FIX 101.000-439.118 $122103
C0 --w, rRVc f0
V7�rt.�IHANICA 11A, -- PyyC��••7gqC>L 1p (y�p,1 ^CI,1Cf�0-4A2/9�a(y7,,�Cg0
�F����,E Q124.0
,P.tii•E.. khJ!J��a 01.-000-46+0 4r' 0 $015.00
P-60MB)NO F�z POOL 101 .000-419-000
SUP, MAI, CONVYRD CMOR AM PLAN CIFIECK
$14 0718.4;
NOW
$407,85
RECEIPT"
DATE !
BY
gra
DATE FINALED
INSPECTOR
I P) 7,4 1G�O
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
` BUILDING APPROVALS
E et Backs
MECHANICAL APPROVALS
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 I I
POOLS. -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
al ?j f
Final
PLUMBING APPROVALS
Gas Piping
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
Sewer Connection
Pool Cover
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)
r
' 0WfRACI OR cannot a... L^•� resoon j
I 9adRv for GENERAL lYEC:IkIL'aT10\S
l - dao r .t+� �SIks drivewarc cerne t SIZE — -I 1 % 25
•± hs. _ __ rs tr.., "` '^'dlni[l4 AREA _
N onere
_ 292 PERIMETER 77 -
+-�(21 1W SPILLWAYS - vralls- sprinklers- tL4ephfres or shrubs-
m - - - - — ----
What access is amde h • pb,a nSyihpi5 --
' . U
•it"�s � + Ti_E CHOICE GROUP 3 SQ 53
BLOCK WALL m �-, OIId that YOfr..thC.ovnler.
- - -
0. E -WALL BY SDC ..' h 4 l••-� that neighbor'. __ --.---- _--
ROB.
_
• - resoonsihil'rtv. COPING CANTILEVER _
- - DATE-- signature POOL CAPACITY _ 11.000 GALS
_ - PUMP CAPACITY _ 102 GPM
P!L MOTOR HP STA RITE HP 1.5
_ --
_ MOTOR HP - HP
� .. � -0• FlLTER STA AIiE 300 SQ FT
It_.: —..-'_------ FILTERRATE —.. 102 GPM
fll'1\TA HILYFi HEATER CTA. HITT U7F. .7Sfl HTII
At L• IAN LL CIROJ'SECTLO\
SUCTION UNE$
U) OFFS '. � .. TURNOVER _ _ 4 HRS
OD- 6
2"
HOOSE RETURN.LINES ---
7 - LAWN y )11:0 SILL SK WER MODEL CAN 2" -
M 6-9--:_ .......•--"- ----;T: I ' 3 IS'� CHECK VALVE _YE$M
�j`/ —..'
PZ - +' _ DECK GASUNE BY _ SDC 60 FT.
pFF5l:1'li " - "BELOW 111IfD81LL POOL UGHF 400W CLOCK T104R
-- -- - -------. _. --- ELECTRICAL BY. $pC-_250 FT.
1t AUTO CLEANER --.
- OFFSET
OFFSET _ ' ---------
9-0 CUM FEWER' ----
PA DECKSDC _._. SQ•9'-5 ..
DECK TYPE SALT R!K SD BCFF
e" G/E STEP_- FT- - ---- —
s[cFDPL -��TeR s - SPA SPECS _
- bESLG�ER SIZE 7 _-RALSEO.18".-_
A LITE 100 ATTS _
AQUASWFTCH RANDYAVA LEVEL SEATS .22" 24' 27" —
JDATE DAMWALL 6 ' X 8 FT.
.O -
O 8!17100 DAMWALL TOP TILED
R - SPLLWAY SIZE_ _3 _ �.X- 18 WIDE
' REVISED __CLOSED_
gJETS 4 LEER LOiYl:_R._ .
RESIDENCE Name: CENTURY f BILL AND PAM MITCHELL '
q - 78 -If W WAKERELD CIRCLE
Address* -FA
CONNECT TO ' Tiaffi: AIARBELIA 2 LAT# 7 6
DRIVEWAV
CITY OF LA QU:INTA Pods
PALM'DESERT TEMECULA
BoscaT a,ccEss BUILDING & SAFETY DEPT. N 73-011 COUNTRY 28910RANCHO
m \O WALLS YET ^ ' 1/8"=1 SCALE STE 206
I j per - �..
CLUB DR. STE F-4 CALIFORP/A RD.
U -A-MSPECTIOIV- FEE -O f $30 • APPROVED', -. .. _.._-- --._ ...___.. .. PALM DESERT CA. TEMECULA CA.
O �n 7►�Ae M� - NojE: LANIlSCAPE AND FI ELN71TIURE 92260 92590
7RIIL BE'GEO I THE APPROVEDAIR: SHOWN FOR IIJ.USTRATIONi (Z6413_4fx9032 (9.091676Sri1M
RE NDT ON _ UCTION— ONLY AND ARE NOI NCLUDED. LICA - S74127
THE SITE FOR A SCHEDULEDh
INSPECTION. DATE
NO EXCEPTIONS! t--1