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9911-138 (RPL)LICENSED CONTRACTOR DECLARATION U) I ht by affirm under penalty of perjury that I am licensed under provisions of -`• H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and C14 U) W Professionals Code, and my License is in full force and effect. O =) ch License # Lic. Class Exp. Date r- d LO f1l W912 r , / �� i( rZ oZ date ignature of Contract �� O CD OWNER; -BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ U) License Law for the following reason: Z_ ( ) 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). cr) () I am exempt under Section if ) B&P.C. for this reason N Date Signature of Owner ON O) Q WORKER'S COMPENSATION DECLARATION C) Z 1. hereby affirm under penalty of perjury one of the following declarations: Lo O () 1 have and will maintain a certificate of consent to self -insure for workers' X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit is issued. Q C) ( I have and will maintain workers' compensation insurance, as required by O U Q Sec"iion 3700 of the Labor Code, for the performance of the work for which this 11 rn F- permit is issued. My workers' compensation insurance carrier & policy no. are: ? CarrierC1 rL'2L;.T1C3iJ liti�i. Policy No. O11'.1PIN9=?1 r- V J (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 ofrC'alifoNia, and a;?n5 1�phould �ecome subject'to the workers' compensation provisions7,00 �f t e Labor Cof e I s II forthwiteomply with.thosdprovisiot spate: // !Applicant `A moi•--•� 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 relatin�q. to tthe building constrycfion, and hereby a ihoriz y representatives �©f'fthis City to enter upon the bove-mentioned property,,'for lnsl ection purposes.% L,Signature (Owner/Agent) � �"'� �.� f - f i BUILDING PERMIT PERMIT991� 43N DATE t VALUATION $ZI1.Y!4)il.litl LOT TRACT JOB SITE 1 19-170 CjkNTio;R.RA ji iZytS:� 1>jealt1G APN - ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER it /41T)C Lt /"Y �l� ♦laIIwJ Til T il:' S.T 4 1ri`:Yt TJr V1T C CtN'I'A M) CA 91761 ( t947•�=3'14 C1:1..d 52140 USE OF PERMIT I't.JtlL AND/oK SPA tai;+[�L 1�N)3 t'A iH3L -Af AkL1A5 }l+lltktltJiS :iliNli.l 1515 fN PLACE A't i114i P11— T11W INSKC ION. FOOL AANTi;tTR SPA 26.0(h),401 i (Xh7T 1 Ota CONN!{. 12`13(11 M0i'ly 20,009.04 LL{jp`. a•�. �-7 e' j z �¢ dVOMIiIAT''''D Ili—AN CfiE'(:'K FEE li)1-t){n3 ,S�y-3lE; 53:�+I,Sti CE'f>d�i't17tlt"17r1Nh'FF fiat-f)f)f)-41WON) �Gx+1?.slA NIECIIA1141C`,AL Iliii -• POOL 101 -WO -421-000 $ZI.00 _ i l.r� etliCrU, t7 l:-404204fk� S�S.eni lei tMiityT,i t Ft?--'E'T.°><�1i. fill -(X54)-411 000 32?.GU c 17' 1 _. r , �.✓ Siltt'itYl'AC, t;flN�llt.tic"t1C}N AN1� PLAN cYiiC Ci.' c�> ~;3:17 35 ' LESS' FIRE -PAID F:3ES VY 00 TOTAI,1< FRN1F1' F KFN 011F,, NOW $437.55 RECEIPT DATE 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Footings Bond Beam Electric Bond Main Drain Approval to Cover ���7 / _ ��. Equipment Location Underground Electric Final Underground Plbg. Test 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 Encapsulatio KA J 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) 13LK BALL S silks E Yls Titl G PLAK)T"C-R- &)AL( - s_ '.�'� `�.`- '..Z.- Wil, •- ````__I.. -:::--4i )• • 'Y �:Y.�.l., 'i{ ,. C X S T'JiJG-. 13�1 COn�C2lETri (a sL3 RESiDErJGE . � ' `V • 20 I Go' 1 i RGCE.SS 414, (A)R LL. Pool Builders Since 1954' (909) 947-6474 E(z (800) 479-5560 MUFax (909) 947-4393 P=92318 S. Vineyard Ave., Ste. A Lic. No. 618892•C-53 Ontario, California 91761 A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. .NO EXCEPTIONS! CITY OF LA QUINTA BUILDING & SAFETY DEPT AP'PR0VE® FOR CONSTRUCTION QATE BY NO PVC GAS PIPING ALLOWED, USE PE OR IRON ONLY GLAZING WITHIN FIVE (5) FEET OF POOLS WATER'S EDGE TO BE TEMPERED GLASS. FENCE TO COMPLY TO BARRIER REQUIREMENTS PER 1997 UBC: WHERE WALL OF A DEWELLNG SERVES AS PART OF THE BARRIER REQUIRED, ANY DOORS WITH DIRECT ACCESS TO THE POOL SHALL BE EQUIPPED WITH AN ALARM. THE ALARM SHALL SOUND CONTINUOUSLY FOR A MNIMUN OF 30 SECONDS WITHIN 7 SECONDS AFTER THE DOOR IS OPENED ( AND SCREEN IF PRESENT) AND BE CAPABLE OF PROVIDING A SOUND PRESSURE LEVEL OF NOT LESS THAN 85 dBA WHEN MEASURED INDOORS AT TEN (10) FEET. GATES MUST BE SELF-CLOSNG, SELF LATCHNGAND MUST OPEN AWAY FROM THE POOL, INCLUDING GARAGE SIDE DOORS. NO DOUBLE LEAF GATES PERMITTED POOL EQUIPMENT SHALL BE A MINIMUM OF FIVE (5 ) FEET FROM PROPERTY LME. POOL HEATER SHALL BE A MINIMUM OF FOUR (4 ) FEET FROM OPENABLE WINDOWS ( Show window locations and distance). RECEPTACLES ON THE PROPERTY SHALL BE LOCATED AT LEAST TEN ( 10) FEET FROM THE INSIDE OF THE POOL OR SPA ORFOUNTAN ALL RECEPTACLES LOCATED WITHIN TWENTY (20) FEET OF THE INSIDE WALLS OF A POOL OR FOUNTAIN SHALL BE GFI PROTECTED. EXISTTNG LIGHTING FIXTURES AND LIGHTNG OUTLETS LOCATED LESS THAN FIVE (5 ) FEET MEASURED HORIZONTALLY FROM THE INSIDE OF A POOL SHALL BEAT LEAST FIVE (5) FEET ABOVE THE SURFACE OF THE MAXIMUM WATER LEVEL AND SHALL BE RIDGIDLY ATTACHED TO THE EXISTING STRUCTURE AND SHALL BE GFI PROTECTED. ANY PORTION OF A POOL LOCATED CLOSER THAN SEVEN (7) FEET FROM THE TOP OF AN ADJACENT DESCENDING SLOPE SHALL BE DESIGNED AS A FREE- STANDING UNIT NOT DRERIVING ANY LATERAL SUPPORT FROM THE ADJACENT SOILS. GENERAL POOL SPECIFICATIONS: (Temp. # MAXIMUM WIDTH: It ' • PERIMETER: , AREA: MAXIMUM LENGTH: POOL CAPACITY: POOL DEPTHS: - 5 TURNOVER RATE: Hrs. EXCAVATION DECKING 11 Access Front Rear Type Q nr" rf Af, Bob Cat Shuttle Dig Color Remove Dirt Risers Remove Stump(s) Footings Remove Fence Mastic Replace Fence Drains11Z— Remove Concrete S.F. Sawcut Concrete Ft. E0UIPMEt4T ''11 Filter T e Size V STEEL Pum HP (2 -S -Bo Sp. Expansive Soil Steel Pattern BH B.H.C.C. a No PLUMBING P/P+/Or Ozone No Filter Run Ftg: 911 SmartLight Yes 0q6" Return Lines 500 W Light No P -Trap B/Wash Line SmartVac II Yes o . Gas Line -Ftgl Heater BTU :> L Nat Pro Drill Drive Div. Board ELECTRICAL Slide 1 Run By Ftg j Water Feature: GUNITE Love Seat \ PLASTEF f� Swim Out Color I.� I L Ext. 2nd Step R. B. B.I_in. X Z Ft. SPA / In Out R.B.B. �_in. X10Ft. Size Plumbing Run COPING Dam Wall Length Type Number of Jets Blower Hp Yes No TILE Type 7_ Remote Model K Side Switch Yes No Spa Dam Spa SmartLight Yes CNO Accent Tile 100 Watt Light es No BUYER Initials • Approve above specifications • Approve equipment location • Understand that decking shown is for illustration purposes only and understand that they are to receive 1 il00 square feet of deck. Signature Date Prepared Especially For: :EZ � r7 Q r7 t "' I o� 1 Street - I � - City LPA �LAy 1 (� Zip—! H•` Work Phone / Designer �Q,'(i�l 5 �. / Job No. ' A Lot Block Tract l Mapsco-No. LICENSED CONTRACTOR DECLARATION U I hereby affirm under penalty of perjury that.l am licensed under provisions of F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and WProfessionals Code, and my License is in full force and effect. O =) M License # Lic. Class Exp. Date r--0 U-) Lii r r` r - oZ r- Date Signature of Contractor CDD 0 J 1.— C) OWNER -BUILDER DECLARATION .W UJa- I hereby a irm�bnder penalty of perjury that I am exempt from the Contrac#torsi U) License Law for the following reason: Z_ ( ) 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). co () I am exempt under Section B&P.C. for this reason U) N Date .. Signature of Owner ON . .. rn d Z WORKER'S COMPENSATION DECLARATION C:) 2 Z I hereby affirm under penalty of perjury one .of the following declarations: LO F2 O () 1 have and will maintain a certificate of consent to self -insure for workers' X U compensation, as provided for by Section 3700 of the Labor Code, for the Om J Q performance of the work for which this permit is issued. Q U ( ) I have and will maintain workers' compensation insurance, as required by OU Q Section 3700 of the Labor Code, for the performance of the work for which this a v Z permit is issued. My workers" compensation insurance carrier & policy no. are: Carrier Policy No. co J (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' comp�egatioNlaw s -of California, and agree that, if, 1Zslm,4l1d�yl�ecome subject to tie 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 $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. �%1s Each person upon whose behalf this application. is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if' work is not commenced within 180 daysfrom date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply.with all City, and State laws relating to the building construction, and hereby authorize representatives .of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT JOB SITEAPN ADDRESS 9gi4_9315P OWNER CONTRACTOR/DESIGNER/ENGINEER IR• d:M it S SITIAN B;..UF 1$.AMN P�} L a 8 S. "A��T {r .iAVENUE, S� ��CE lig USE M OF P R 1JTC{4_I � A31 LA C, L iNTA CA 922'x?• ONTARIO �",t1 91.761. l�ii:+',). elf.-ty'•! .t_-_ ��_. y t POOL. A�ii.3: O'K SPA P001, AM SPA £.lnfLY-ALARINAWAAT RIERS l3HAIJ. BEW p''LACE!4T�'fd!"s PLAkvTJA INSPECTION. i F03i.:ANDI R SPX :2;0,000.00 us V CST VNIAT ED, C OST OF C'tINSTR.I?i:110ltd 2tI,CtS1tI.aI43 PERMIT .FRE SU AIMR Y. PLAN CHCCK,FEE L"(3NSTI4WC",TTON ME 1,Ci-000-iib' U(10 '07.tifS MECHANICAL ~'EF —POOL 1,01-000421-000 $'21 i00 ELFCTFUC;AL.TFER--,E00L 1.014rIO-420-000 345,00 IPLl MBI[NO FEE — $27. W.1 S{:lS.3 AYC.t1L 0014KIR1;.it'."'= ION „SAND PLAN AN C ECIC $137.55 TO;CALTERMIT. 1rf .C1i S DUE NOW 1 $437.5 RECEIPTDATE 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 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Hacks Footings Electric Bond Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test 2� Final I 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 Z — 4 • ccv z 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)