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9606-031 (RPL)H N U) NW O ::) (D C) LO w �Z� �0� (0 P WJUCL (0 U) Z co N ON U °) EL- Q Lo QCr 0 0 J J m:Q U OU rn H ,It Z ob 5 0 Q J LICENSED CONTRACTOR DECLARATION 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 Professionalsode, and my License is in full force and effect. Lio.rsb # Lic. Class Exp. Date 2n+iO4 C-53 Date Signature of Contractor ' OWNER -BUILDER DECLARATION 3/11;96 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 isnot 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. —(t' )'-•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�'IpS,!�jqjF.V1y� RQrtis' compensation insurance cayrieC8t(p3oJ�cyOrtiq. 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: 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 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) Date PERMIT # CONTROL # BUILDING PERMIT 3466 DATE VALUATION LOT TRACT JOB SITE -r 4- p ADDRESS '79.110 i"..A.1�i.�".E,R.ft2JV 'Y APN OWNER CONTRACTOR DESIGNER ENGINEER SG s yi%y%S4\ftrti� 71-110 CI'iAit'i',ERRA CIR 73555fl WY 11.1 LA 1. FANTA CA. 97253 P.ALN'1. r_JESHM, CA 92260 :340 11a USE OF PERMIT POOL ,Alii l.>/OR SPA f'0CSL 1M:Y POOL AMWs;' R SPA.. LS '^. �, T:iY1: '�' (U b"�T1k' 'lot I1C " f ii 41 i1,1iA1.1i + ti y'd i2CJ� "1'f af`f f 1?l 10i.=B1C! .41.31-000 $1.17,00 - PLAN 0`WCK PEt' 101-000.4-19418 $76.05 kILCUIXNICAL FRE POO:. 101 -000 -IM -M.0 $24,00 F.L.ECTRIc,AL PEX,'.., P(NOT, 10j-000-420.0110 $43.4)0c� P1.[fibiBfNGRX, --PC$Df,- . 401 t?0(}..t}I<i.UOt) 527.0 © � - SUB-TOTALSrONSTRI CTION'.E'F:'a ii.PJ.^!:11 CH 4z...K LESS :���:.��,�i�� F :-,l X0.110 T Y�AT�,i�;1;;,t1�1!"H.' f+�:.IUS A)UET�!O V RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR A BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forr7iis & 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Flnal 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: f PLID �S I -n.L-e -Ti mk �Lz7C.{_ MASTER PI LS&SPAS:, • Designers & Bu11ders for aver 35 years - 73-547 fiighway I 1 I/jensen's Shopping Genter Palm Dew t, California 92260 619-346-6115 SWe License # C53-238947 ACCU1311 MCS M-OP 9 NO. A6+Bat9 r44 i.$S SPAS D�dU1 Ssf�riCi1 E:71�*�I�c.R�3i !� fR2�F 4 hy fib *11 plane shall be referred tD 9T� LS 6 SPAS for vwftatlon Ware prvmmding i4fyiIlfi 06 k. lI wdfk ptncfeds wiihout varifjeaf imp. <wvm ctor 0M M @e Va alwri r�r;:�- :ry and ass4ilrres 6Ui TlaLiliSyll9 iTWV Incur. TI 60 foie plans, dikapn, L,-:; z artd wodfi=ores iirWu&d nnihain the limpPerry of SR PWLS s SPA . Arli use, raproduetaon, publicalion ordrsltihrztialT in any iturrt or Mltlter ir1 whO10 Cf Jn pertwilhput llhe wriftq C-On ESPt a! fwL STSR FOOLS & SPAS is prohibited. VJ W COAW wm these pJafis steep aonsavits acmitmea o r etese reslrictiQe I5. I 4 i I APPROVED; A CUSTOM USIGN FOR: - I HATE; . L, SCALE' MCI FICATtpNS Si ra ' _ a Voaum¢ GaN tr++a. Tamoiae■ No. grasp, Surface. - `_ PMriS 11F, ❑epths. Hlinirwrn le- —maximum &oak._ spa 5ile _ T rP._..VorurrJe — ralaa+is. EKCAYATiCN Finish Elevvkm 4 Vim, ,AM1asS7od- I} l- G A &A- nDL- Inc Prrrperatron Grading I • Dirr RarvarJLaadl rxa❑ilm •,b✓ `- Are Nile Lmlion' FanGa Removed Isy" RaPIPCW $7 5 I, Yarial - Si2e of opanin 1 NUTZ, Na Paintinpar mewhingof censure will b*.dMjI .; Ira PLUOiNiE, Fllrrr Type {' � ' I �'� Srxe N-V Type yh Size Ay , Si to - Skimmer Tytx • -' r Nd, Hgam TvP 1 � Size — ■> Heater vem By �r� •• - Jet Pump Ty - S12a _ StOw,aF TVJ- �Qulpmarit j'1+ PlCS1ablPit -r �� Plumb -no Mairrial suctron; Sim � Largxh— F:, CiMhiFyr 8,28' �, Lpsh--Fees Wswo F SLIM Length _ Fart_ Requrns.ln PW Number Siaa Lemh r*et Aatum Inlawr type '~ W I La~ D - pill untie iw th No bitnlr ons 15+3a�gxh. T Fs. AI$ Valve LQcatkos. C4T5 iLIRa By ,Ak Siee Lang;h— Fees, A418iT7a Yit C�eminq SPA INFGRhkATION Sur:tium'Siae �pth, — FL _DIZ QLS1za-_ Lash. — Feei Jai Type umbeg' __ Jet Air Lme Number,__. Gbe - —_ Lappth Fret Slower Return Slzs Length _ Feet. Serftlor V&Lve; Typr: Nurriber_ __ Filter Type Sian Pump Type. 5kimmfr Typo FLQatrr Tvnr' - ._ „i�£iaa _ l"IRix r ViCt EY Jet pumv tvRa Sian 1141WMF Tyffw_ Egw0mM1am Location— _ PIC 5tat3j!`t FIJJmt}IngJrlitfrial - ,• -- - Sucuon, Sila- Lrnpth—Ft. Pischargt Size— L.grh,_lFcr% UVaat4 T. Sa12i Lerrpih T t-eet_ RelVerg In Poor; Number Sze - _ Lrnprh. Fart- Returrl Inlet Type Fill L6 (With FS, A1S'klalYr Location. Gas Line fly Size_ -- __ _ i1br4ti F"t. Autt�+ jlcCleanihq '&"FEEL ttaisad 84nd flaOnF; 6" �7'�2'r ��� f$"--`.. I3YrierT - Sao I]ani:waN: F*ps - GLINITE CPRrsEr ft ,.Inllll �.J .Teti $Sept- Fill Line Gr#h Rtai Hand Rail CUP.AnphOr;.L - 5eaLlB�ncM1 Sao Inforroauon-J;f.iA r,� TILE AAID COPING. Tile .Color _ Cp{nofOthrr CarttilavpR w , Trim; Numbneed T. Brick r Sveciai glazed: See "STEEL". ""UNITE'' FeLEGTRICAL Iti t �" ` COrd Length FapR, "J" Boa Lacrrbn Elvrscrl L=tinr+ Filter Run S, J4" Run Ft. LiphS Run FeEi_ switch Run --- Ft- kCh#nge . Spw swiSoe C Tion is Heater 8Wi{eh LOcaziun?J ;di. - QEGIf I k6 Finlsh -. Fr. Color —Rail Agwior, RrserS._ - -FL Emoanvon: -- - SSarxlq[ds:- Oeck Drai rcLAST --- • - - ---L'�'�- "�•�C' S� rn�Ptasai �- — �ieceved. tQps�J�;�-_ Cup Anchors _ - -. Rad Anchors .r_ . [hill} } BATE: r•t, NAME i_ ADDRESS — CITY_ PHONE AREA _ I j dWN. B CHi(. 8Y