0009-219 (RPL)-LICENSED, CONTRACTOR DECLARATION
!:hereby affirm under, penalty of perjury that I am licensed under provisions of
apter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # 4 tic. Class Exp; Date
374!97 '»�.
vD` to C f 6 0 Signature of'Contractor W C2 f
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 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
uate Signature' of Owiiw
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.
(-)/1 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 STATE FUND Policy No..' oo-ov_oomu
(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 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] 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
constructiori, and hereby. authorize representatives of this City to enter upon
the above-mentioned property for,,inspection purpo—ses.
Si gnature (Owner/Agent) ` -w ^ — 'Date O C
PERMIT#
C BUILDING PERMIT
/
DATEf VALUATION LOT /LTRACT
JOB SITE.
APN
ADDRESS %trVMD (".ICRC7.I'
- -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1dlJ.tA KERZOly
Wrt>V DODSON COAs ocrloSri Mc.
7€-81,35 WLE MIRCLE
13011 CL1W TRY MUD DR, SWTBa' F4
LA QUkJ!'A C,i4.. 92253
PALM DE8RFCr CA 92260
(7,50)34640 32 CSIX 1044
USE OF PERMIT
POW A14DJOR SPA,
POOL & SPA OR LY-ALARMMAIMER.S SHALL FIF IN PLACE AT PRE
Pip-k.jT ;R I NU;FAMO1v. POOL l:t2U1►PMWl Epic Le-9URE IS 140T IkCLiJi>ED
IN THIS PERMIT
POOL.ANDIORSPA 1819501001A
l'IdlIIA77D COST or C•'i).1 .19-m V enon �
1�I,950a00 .
q,� ,}� g �jp; g •�•y �y,y 6 yl��yWy
1�.lSraS.LS.i�.�S`L°.Pi1'AiJiY7..R!lai6�d.
PIM CHECK MEE 101.000.43MI S $123,'
CONSTRUCTION FEE; 1101-000 419-000 $1913.00
MEC.I'1At1ICAL FEE -. POOL 101e,000-421-000 $24.00
ELECTPICAL FI:I; -- POOL 1409 -000-420-000, j $45.08
PLUMBING ME — PCOL �; 01.000-419.000
I
L
OCT 02 ,2000
- VF LA WW.
SIM -TOTAL CC1WKIRUC1IO .MD I'•'LM CHECK
°x',422.70
IZ33 PFX_11A1D F
$0.00
TYfAL Pte ' DDS N'i?W
i
$422,70
RECEIPT
DATE'ay.
BY , } ^,
DATE FINALED
INSPECTOR
t
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills "
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
-
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric (p
_
Underground Plbg. Test$
Final
Gas Piping
PLUMBING APPROVALS
Gas Test (o f
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 k �
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Powerr
Final
Utility Notice (Perm)
COMMENTS: �,� 4h►
W
ChoUnderground
11
Q\��
CONTRACTOR cannot assume responsibility for . GENERAL SPECIFICATIONS
NOTE CRITICAL + LA QUINTA HOMES damage ta--curbs. sidewalks, drivew
MUDSILL CROSSECTION SIZE 12' X -3.0'
SETBACK TO GRID !
t : slabs. sewers. lawng.,Jrees, fences. retain
AREA 257 PERIMETER 69
walls. �
prinklers- telephone lines or shrubs.
rWhen access is made through a neighbor's DEPTH TX 5' }
' WALL AT 10 FROM X HOUSE
property it is understood thatyou. he owner. TILE CHOICE GRP 3 SQ. 55
CHANNEL WASH REAR FACE OF WALL MUD SELL have that neighbor's permission and assume full 96.— — - — -0 — - — — — — —
SET POOL AT. 8' FROMP/L 1�ECK responsibility. COPING CANTILEVER
1 2" BELOW MUDSML ` DATE ____ signature POOL CAPACITY 8,710 GALS
STRIP FORM FINISH WALL I PUMP CAPACITY 102 GPM
STUCCO TO MATCH MOTOR HP STA RITE, HP 1.5
HOUSE -M96TAR44P- -9 - t��
- - - -0-
E GRID WALL4FILTER STA RITE 300 SQ FT
AIR PIPE FILTER. RATE 102 GPM
TY OF LA QUINTEATER LAARS SIZE 250 BTU
1 URNOVER 4 HRS
{ _ BU LDING & SAFETY DE, `SUCTION LINES 2"
' "
APPROVED RFTIIRK. LINES 2"
8 -0
LAWN OR CONSTRUCTION SKIMMER MODEL AMERICAN
AREA +12" ; '�, '; CHECK VALVE YES
' '% GA§LINE_BY SDC FT. 60'
(O
3' ' O E 3 0o 0! L LIGHT 400. W CLOCK T104R
8 'R7'-0" 5� >� CTRICAL BY. SDC FT. 250'
F1. 19 -3 r �f PLANS AND j WILL BE CHARGED IF TH APPR - - _ _ _ _ _ _
3„ 11 - JOB CARD ARE NO
--------
9'-0" — ' 18" \ 5' THE SITE FOR A SCNED
18'-8 1f 101-4
INSPECTION. STER COLOR WHITE
10 -4 NO EXCEPTIONS! DECK BY SDC SQ. 820
MASTER
DECK TYPE SALT CLR. TBS
P/L BATH MASTER f SPA SPECS.
[1] DESIGNER SIZE 7' DIA. RAISED +18"
LITE SWITCH � RANDY/WA LITE 1I LEVEOLOSEA SA 2'WTTS 24" 27"
1 WATER SPIGOT LINE' .-
DATE DAMWALL 6" X 7FT. -
4 G/E o 8/31/00 DAMWALL TOP TILED
{ �I v� . SPILLWAY SIZE 3"X 1'6" WIDE
'
91-10.. 1 REVISED SPILLWAY XX OPEN CLAD
# JETS 4 UPPER LOWER
RESIDENCE i •• ADD VENT Ile: CENTURY / BOB PIERSON
STACK
TO HEATER WAKEFIELD_ CIRCLE C
- Address:
LA QUINTA Q
TRACT MARBELLA 2 LOT# 4
.�
BOBCAT ACCES Dodso* � -rr
NO WALLS YET '
N
Pools
PALM. DESERT TEMECULA
73-011 _ --�- - COUNTRY 28910 RANCHO
. 1/8"=1' SCALE CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. STE 206'
NOTE: LANDSCAPE AND FURNITURE 92260 TEMECULA CA.
ARE SHOWN FOR ILLUSTRATION (760) 346-4032 92590
ONLY AND ARE NOT INCLUDED. (909)676-SWIM
- -— I # A-574127
1'