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9607-025 (RPL)C\1 W O Z) M C) Lr) W r O to P: w w H d Z M rn CV ON U °) It D_ Q Z Lo Q O LL XW — mUU O rn It Z obs �p Q J LICENSED CONTRACTOR DECLARATION ' 11 1. 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. - i License # Lic. Class Exp. Date 3{ / C-53 ) r t ! Date'" 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: ( ) 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 tis u?tdLMy� ers' compensation insurance ca�rlve�r-&jpol�cYFng. 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: ADolicant 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 I have read this application and state that the above information is correct. I agree to comply with all Citz, and State laws relating to the building construction, and hereby authorize epresentatives of this City to enter upon the above-mentioned property for i pection pur' es. , M Signature (Owner/Agent) Date' h7 14;ll BUILDING PERMIT PERMIT# CONTROL# 3682 DATE ^ LUATION LOTS%-02:� TRACT JOB SITE APN ADDRESS 79-100 CANTER" DR - OWNER CONTRACTOR/DESIGNER/ENGINEER �t311. rC1�.o I, 111AS't'ER POOLS '79-1.60 CtLNffikIR A DR"' 735.55 HWY ! 11 Lak OUIN'TA PALM. DESERT CSA 92260 ci19)_ lE;rnt1:5 C'1%# 16 USE OF PERMIT' POOL ANI. Ok S.wA :l`' YA. AM) SPA, POOL A.NllJOR SPA. f I,OCitl.tffl LS 1'"S iMA7. r.10 COST OF COiti'ST.1k1JC71:. IN MARY 4CINS'1'.Rt.'C310N A 101.000-418431J W.11. 4- N1CAL FEE -» IN)OL :101-000.1.121-000 S2A,00 1►,f >: f'1 ac ;al. FER __ PCX1f, 10J-011114�0­000 $45MO 1'(,1T1441 1NC3 }Z l; �.1>Cskid: 101 -OW -419 -OW $27.1111 SUB -TOTAL O.1`Ty. RUMION AND 1:`tAN CHECK $303,90 1..l:SS RPM -PAID 5 40.00 JUL 2.1996 Flit RECE1 _ �,- BY. 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 POOLS - SPAS steel Set Backs Electric Bond 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 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 Fbtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Ll fE WKIr[k691t) 1Nb b - Ca" WIbE TfLt� bvW WL LA, _ FA KA41.J w C MT1(, -- r,i_ Designers & ft Iders for over 35 years - 73-5474gt way-11 PJensen's Shoppirig Center - _ -- Desert, -California 9260 -�- - - - -- - - -619-346-6115 --- State UMSQ # C53•238947 CCSPGRAfWCA A£ORUEh xu. AG14+79 APPROVED: A CUSTOM DES GN F1aI'�; I I DATE '7- B - uW ComDifflONALLY ACCEWEIDFOR-COWTHUCTION SIibElyj�ti 9i 4d��I AS PER DATE [SATE: SCALE "sir- T1 �►. BY ILL SPECIFrC.ATPONS 11alumr --. _ �--. Gallons •ernf}I6ta __ _ 5�a� �'�•�� edthT Maxim urn t { El' - a SpaSia° s4 -- Voru+ne EXCAVATION - — - Frn sh fIe Eton !r'. 7deth*d rL+ -- _ Site preparer.gn � flirt Rerrievai Laada' TG PumP �s-_ -_ w _-_-- Dry Wei! Ln[aT,om _— ... Femcm Removed 13, � eplacW Byr aterail�- NOTE }•Fo parniinpor mmiciTing of rekFur#r Jl Cm done+ P�L}IJ-AtR�Bf�IG l • --- Frfter Type{,L,��7J Pump Type- Skrmmgr IVpeAlv_�. . _ Sire Heater TYPE Fra[er Ven7 By STAXL _ - --- JeSPLrmvTrPk.C-dr+'(-h'L�.af----- Etivn rr Type Equipment LoCdtron NW-tim4p ma Sucuun Slra � _ Length _. _ Fr D,eChar 5rxe r{- - - nY R �.. • LYih. -_Feet � WNSTe Ta _ Size _J Length _... Fee}. Rswrns .n Poor hh.rnstw _. _ Site Ail-rn Inivi Type 3 _ L 10 Fill Lrna IW,KK +q Truct- n !L+ � A SrSr=e_tl�l..rr F1..4{S Y Iva LOCeI,On- '+ Goa Lrne By - Lenyllt AjutornatiC GF4arT+n¢ f SPA INFORMATION rtu+lctimn- Fitt Lgth Ft, Okwhp.5iile — L_go FeeL Jar Type Jrt.4+r Line Number _. . . _ rfe Length —_-- - _ Feet Bla"t R*tu- Size _.--, , i.argelt Feel $elactor Valve Type - Number' size _ Pump Type- Skffnruar Type .. _ - - �.T$rxe - _ _ • va — IieaTer Type-- Heater Vem By - _ -•_ �.�_ - JeTP�mRTY��..�-- --Size -- -----_. Brown Equipmem,LOCeTrOr1 _-- _ - — - P1C Sta�lPil - Rlam#nlgChiatarral- Suction yi:o- _----- Length __ FS. Ols[hxgR Size - _ Lgth_—Feel Waste Tom_ •. - T 5u#., - LAAW(T ._-- Fret. RlTuins+n PpQI Numbar _.,_ . -Sass -_ _--.- L"rh _ Fier Raturn Inlet Type _. _ _ e. far LrrT# MA No Obal r ucfions l.°ire Lgth Ft. A15 Valve L4cat4rN • Gas Line By -- S,za - ...---Length Autematic Clearing STEEL Rated Bnrre Rea- b'• . _ IT Spa Dam WaII Peel CsUk17E Corner' fi i r'__�1_ �rn leCf- Jet3>-Q!LL,_ SZeRs _ _ _ - -fill Lino Location ELPLAeQ Grab Rai H%e%J Rail_ Cup Andtori' Seaiff3encir �� t� ��� ,. _ Spa rni4rm#5,0+11�� ■%� TILE ANDCOPING Trla Cplgrrf�+ CaP•nglQthar SPecralDet}rI See "GUNITE" --- --"�— _�- ELECTRICAL f SY -` Cord IL t J•' 505• LBCattOn __- Swi la Lo"hon� i FIIT#r A-un _ _.Ft. Jea Aun . _ Ft Liphr Rum Swrteh Rum —._ - . F I Change _ Sao Switch Locafoor+ A. Nearer Swarth LoutioR DEMN6 By�iir - Fihmlt _ _ _ __ -S Ft- Color— «-I:onjW*m _ _ AA;l Anchors Fl•seri- - _ Ft Etrp lnsrort. �Tb ridg7ii�--,�- --- ...Baa.OJSloae�--- ,--•� _.. Heck Dra.rtil,_ Lights Nzret Plata3 Ret+ltaed 3101:1r CUP Anchart ---Bair hnchtrs _Cui:ls _ NAME - �F-7-L `- 40DREsS-79-100 + � CITY Lzi, CAL IM--r AREAL CHI(. BY FIEEi OF