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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
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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