9610-021 (RPL)U
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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
Professionals Code, and my License is in full force and effect.
License # ; Lic. Class Exp. Date
2238''947
2 t
Date t1^! r^ 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�iss edF-My4'vJorlkers' compensation insurance csrriet•,&f`0"61ibVA. 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 pro Ivsions of Se io. 3700 of the Labor
Code, I s all orthwith comply with those�rovl!�slons. /
Date: E' _ 411 R Applicant iii . (-
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set -forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct.).agree to comply with all City, and State laws relating to the building
construction', al -Thereby authorizlrepresentatives of this City to enter upon
the above-mentioned property for nspe lion p r ,6sq's.
Signature (Owner/Agent) i ^ Dated ? n
PERMIT # CONTROL #
BUILDING PERMIT 9610 -01 4185
DATE gVALUATION �j�[€}s{}lj(P,(j1) LOT TRACT
JOB SITE74-130 ���11<•1��RRA
ADDRESS_
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
:!1412 91.1T{.€- i/vm
KIAS'IER POOLS
7355514W Y 11.1
(619)'iQti-0115 'f3I.1i 16
USE OF PERMIT
1,oeyt en►ly ,
� i.��-%i., ru�i�rver. ext n. t civ, •r tw.2
€��'1'$�xe�'T�+1� $:(�:►`.�' �I� �O.P�i�'I'1b1,J�"3"1C➢ti
�(3,{1tI3.d143
V1.JXK t:,f ECK F013 $76.05 .
1U 9 -M -AP 3-110 S Z .11:.00
,%IMIA1VICAL ELM V00F, 1101-000-42i.-11() $24.00
,6C1.'k1CA1.. FEF --111_ 0t. 101 -OW -420 -OW S4 i.00
P1 l iNfUNG 11,1ik, -- P001- 101-000-419-000 7,+)+►
St.l134M.A.I. CONSTRUCTION AND PUN CHECK
$280-05
' IXSS 11 L. -PAID
$0.00
1, PERMIT FKT�NOURNCAV,
S2.99,05
OCT o
1996
RECEIPT
DATE
BY
DATE FIN ALED
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test cxc
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
COMMENTS:
-
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)
I
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AHD ALL APPLCABLE OWE-8
t' Lri� A LJ rjy
w��w-a-)P Wn,&SPAS
—" — Designers & Builders Since 1958
73-555 Highway 11 Viensen's Shopping Center
Palm Desert, California 92266
619-a46-6115
State License # C53-239947
A PPRUVED :
A CUSTOM DESIGN FOR:
DATE �0- 1 .
IV
Kl�i�•4fc
I �
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1
J-15ox. P'T E.—Ole.
��P-�I-lam N(
�sCAL E CBI Y !i—+J
klnlass naiad all cwensions ere finish duurensim and aff
Movabons are to top of bond beam.
hMASTEq POOLS & SPAS w91 interpret that mslbrting ai W
Pan at the Plana about which any misundarswiting may
anise.
Any dovl iinns from plans shall ba referred to
MASTER "LS a SPAS for verifcanon bofore pmewirg
with work. If work propg*% withoutviodEcadon. contacRW
incur.hishis °wri `93RU sibiiity and assumes aff gahifity ha
faayTitlen Illta inzh,Cczi9^'layoul2-ndswe ficaHonsincluded herrtin rprrkliri tYir: prvppee S flf
MASTER FOOLS 8 5FA .
+4rly use, Tproductllpn, Publication ordfstriGtltir}Yt in any rCrm
arRraltar in vi iola or in part without the wnt?7mwinson,
of
MASTER POOLS 3 SAAS is preit+hited.
Visual contact with theta plans shall consti41a acovpuv1 ca
OF tnaae res Uivio ns-
DATE:
D U. BY 6.6JLLI
�AJ SRECIFICATIDNS
sIG � iirL.T YOLUrne
Ttmd:te No. Shape _
Sri rlaves_ Prtr maser F
COPlhs 'Minimum Maxernum
SP'r ,517R �`_YPlu rr+e _-._ j„i#IIPhi l
—` - ---- � EXCAVATION --- — --
F+n.sPS EFewar•on _-rrrBSh Da tC [}
Grading
b.rT Retrwwal-Loads To Dump -
Dry Vvell LocaTlon — ---_ _ _
F I!r7C0 RemnY4A $y -.. _AiPiiced Ry --A,#+terra! ,,._.
site of oPen,ne -
NQTE: No painl,nq oa nmTr_•I,nq of ihturo wrll be rianal -
aLVhI�IHG i
f i
F,Irtr Txps�j l.$Ixe 20
-
Pump Type
5klmrrter TYPe.Lwl� G3t1r ri' J. S xe 3,'r—
Heats, Tyc - --- -Site
Heater Yertt By
Jet iaurnp tr,rPr-- Sire—
Rtowar Types- - _
Equrprnenr Loeat,4,
Ri ;G $IaB?Pn
lYrnbtrtg Materl9i��,
: r_-.—_--- _
5ueY,on 45irG '_-- Length Fr NxharQeSirr,:E- t.Qltl Fee[
Wish TEL-- S+re Length ._ .-.. - — Filet
Rol urnr In Pool Nurrrber __,,,Z--Sale Ler4M------. Ffft
Fte,urn Inlet Type -tiro �
Fill Llna Milk ND QtK[rwehonslSazePith. _ _ FT ArS Valre LnCarlon
was Lrne By Si,* Lengli+ ._ FeeT
Automatic C[e;n,mg
SPA INFORMATION- -- ----
5ucilpn: Site myth Ft. — ❑,cChS. ]+i■ Lgth fast
It; Ty"
Jit Au Lana Number �_ S,ze —._ _ _ -LeNih
Blower Return Sits —Length Feel. '
Selector Yalwe. 'type Number
Piker Type -- --S'ie-
PumpType A _5ua
U,fn-or Type _—Site
Hearer Tvp Sire
Hee[w Vent Sy
Jet Pump TVF.L-- ----��. S,a■ — -- -'--
6lawer
Equaprs�ent Lcaargo _ �. _ . Pl sj-,_ PAt
Suction. 5,xe . __- Lergtti F! 104scharge Size— Lq[tl,—Favt
WesTe Tn &24? -" —.—Length
Returns in Pool Number _ Size - ,.,__ Langit1_
ReturnlnlstTypo-
fill Lind I.WrTh No 013SI ruetiOnt%oler_ t-gth. FT A!S Valxe L=p1,on
Gat LrMe Ry - -__ - Site —_Length _ Faer.
AutOrnRTFc Cltirlhhg _ _— _ —. _ -
STEEL
Ra sad send $an * fi -- U. - - - lE OYr,er
Spa aazn Wall - -- _ _ Feel
Corner _ InrRtS _- Je[� X-
SthpF rn ihAY .F,il L=rn LOG i,on
Gtob Rail - Hano Ral --- Coro Arwhors
Sato k-
lenrh
Spy iniarrrrarian _ - - --
t' TI LE ANQ CC" NG r
Trl■ 5,��
[i,Yf1IrICYir n'y
Trlrn'YC7 NumlyerodTlra��
Brink.-
5Pscra.l Qeq,l See 'STEEL" "OUNITF•
ELECTRICAL
By r *_T Llgh' 3y,.,; ' _ Corti LerWi Fstl
"J" Rpx LOtauon rL7 TZI q I r Switch Locan an Xi_KQ�7L" I
FOtor Run _ FI le'. kun Fi Light Run Feel
Switch RLpn— --- -Ft panel CI*arigv
Spa swim'I Lothar
siea7er Sw,Lth Locat,an
DECKING
Bvc i� f.nrrn _-SO. Fr- -
Im _Cantu over — . _—Rao Anchors
--Ft. Exvans+hn._--
Standardl
Dock Draft!~
--------pt,ASTEq
L gf)j, _1 — -Mama Plmol —+ _ — Rcoef4ed Stops
Cuu Anchors -peii Anchor, --Grills - —
NAME
` CITY { Ll �
PHONE —.
AREA L rrl�13i
CHK. BY
SHEET OF
-,CUbRPPHICS PIEOR DER NO AGdRr15