0005-267 (RPL)LICENSED CONTRACTOR DECLARATION1.
I hereby affirm under penalty of perjury that I am'licensed under provisions of
.-,Chapter- 9 (commencing with. Section';7boo)•of Division 3 of the Business and
Professionals Code, and my License is in full force and effecty
License # Lic. Class Exp. Date
111
�%{ 556236 C53 �. 02128/21
D.atel L��- 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: y'
( ) 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 is issued. My workers' compensation insurance carrier & policy no. are:
Carrier i'Ait 3ERS INS,CjROU Policy No. 14200MI
(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 manners as to become subject to the
workers' compensation laws of Californi ,and agree that if I should become
sL�bject to the workers' compensation p visi sof Section 3700 of the Labor
Code, I shall forthwith comply with th a pros ns•. F,
Date: Applicant—
Warning:
pplicant Warning: ,Failure to secure Workers' Compensation overage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person. at
whose request and for w}ese benefit work is performed under or pursuant to
any permit issued as result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result Of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit°:or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I:agree to comply with all Oityi
and State laws relating to the building
construction, and hereby autho Iresentatives of this City to enter upon
t above-mentioned propert otion purposes.
Signature (Owner/Agent) � Date •y
Z -.l
1;00BUILDING PERMIT PERMIT#
OL;E3i3-�•Pi
DATE VALUATION -. LOT. - � TRACT
JOB SITE+�f�9Af��}y�ysv�N���y" .
APN
ADDRESS 8.92.0 VWa�A4e7ei,*J{:.2.tRI
OWNER
CONTRACTOR / DESIGNER / EN &NEER
TSttlI.Fia EMURY
swom POOTIS
i$ -9201t+3 i .� U
028 EL -HORIN Int':.
Lr'3. QUIN TA CA. X2253
PALM DRURT 'CA 022.55
�r
(160)340.5521. CRL4 1f0�
USE OF PERMIT
POOL AN IOR SPE+:.
POOL &_ SHA ONLY- ALA RNIMAR.RIERS SHALL UGiN PLACE:AT
PRE-PLA9 I.ER INSPECTION. POOL EQUIPMENT EN&ORIRZ NO
1'NCLUDED IN THIS PERA1,1T.
FOOL ANDIOR SPA 10,300 00 W
z;
ESTMAaw' ' Con ar cot IMUC'lJiOR
PLAN CHECK FEE 101.000.439.316 $117.60
0014 ST,R UCTION FEE 101-00(a- 19-Q00 $1110.00
ME?CHN141CAL F&.F -- POOL''; 101�V00-4.21- f000 $20.00
07.=f'R1CAL l — P001< 101-000-420-000 ,X45.00,
I#1.eLIMf DIG FEE .. P0014 101=000.419-000 , ''" $27,00
SUB-TOTA1, CC13rt'MR.i7tTt'SC+-9AM P;'.AW CHFCX
$31M.00
USS P'.R -PATIO FM4
$0,00
TCYrAL r, Mdff ME .8 DX1T NOW
RECEIPT
DATE
By, i41.
tJ/I
DATE FINALED
INSPECTOR .
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
. 'L—
Final
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
Gas Test
Appliances
Final
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:
e"r L
a
N
_
GENERAL SPECIFICATIONS
CD
001-EOUIPMEM
'POOL
SIZE
O
N
CIE
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to
POOL AREA
POOL PERMIETER loo
DEPTH ro
>
COPING v
^ r�'
-
-
POOL CAPACITY ArPROX 000
-
iFILTER
CL
4SH SHEAR DESCENT
TURNOVER W,2s
m
4
34
14 '
ROUGHT IRON FENCE
t
PEE CK1 NG
12 D''
NIAIN DRAIN lr'VoRf
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SHILIMER L106EL PQRr
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ELECTRIC
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ER 1,101,11,
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SPA SPECIFICATIONS
SIZE • 7'
O
• �7✓�
N
CI ■ • OF
BUILDING & S AFETY DEPT. •
A RE INSI'�ECfjO rr`r a�'
SHAPE CUSTOM
JETS 4 ,
RAISEDo"
WILL BE CHANGED If THE
PLANSAND
BENCH
BENCHES
BOOSTER
APPROVED .
106 calx ARE liff on
CONSTRUCTION'
THE. SITE TOR A SMI) UD
rNr DOLEN FAMli-Y-
C.
FOR
INSPECTION,
78-920 WAKFFIr�LP
y�jO.iva.GACEPTION�.:
LA QUIN1-A, CA.
DATE
•
^ - _ r
-I
APPROVED BY:Lk
.. xv,•,. . ,
(760) 340-6621 '.
THIS DRAWING REMAINS THE PROPERTY OF SUNRISEEPRODUCTION OR
UNAUTHORIZED USE
-
PALM DESERT, CA
WITOHOUTPERMIISSIION IS PROHIBITED.
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