9609-167 (RPL)U)
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LICENSED CONTRACTOR DEC ARATION
fl hereby aff irm under penalty of perjury that I �' 4k�en"Secl under provisions of
Chapter 9 (commencing with Section 7000) of Divisibri.3 of the Business and
Professionals Code, and my License is in full force and effect.
License # , Lic. Class Exp. Date
9447 C-63 35106
oellate7 :,�)4 11 hGO Signature of Contrnrtor+�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury'that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
I am exempt under Section -, B&P.C. for this reason
Date Signature of Owner
WORKtR'S COMPENSATION DECLARATION
I hereby affirm _' under penalty of perjury one of the following-dec * larations:
( ) I have anla will maintain a certificate of consent to self -insure for wo�kers'
compen tloo' n as provided for by Section 3700 of the Labor Code, for the
p e or �f the work for which'this permit is issued.
�Jj;
rfor
ance
,0 0 1 ,
1 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 isriYS`dEUk1y4'0'rkdrs compensation insurance c IT po icy no. 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: - ADDlicant
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 , J have read this application and state that the above information is
correct. 1,,eagree to comply with all City, and State laws relating to the building
con5j�dction, and hereby authon 'e r p resentatives of this City to enter upon
bove-mentioned property for, ainp"d ction 'Purposes.
PERMIT# CONTROL#
BUILDING PERMIT
9409-167 1 4147
DATE 9fZ4/96 VALUATION $0.2.6N.00 LOT TRACT
JOB SITE
ADDRESS 79-205 CAANTERRA. OR
APN
OWNER
CONTRACTOR / DESIGNER ENGINEER
'WILINITITH
MAMT R POOLS
/f6o cxN'rEkRJk
7.3555 hw Y I I I
1, A QUINTA CA 92253
P A L N T 1 311-1 -S E R 71' CA 92 -4)
(619)346_6115 C"11# ki
USE OF PERMIT
KRA., ANWORSPA.
P1001. &SPik ONLY
vs,row.,co casT o;, comi'muc:f toN,
PER1041T PEP, SUMMARY
Pt.AN CHFM FER
CON3TRIUCTION FE, E $144,00
'Mr- C.1 1ANICAL FIM3 - V00f, 101-000-1121-000 S24,W
P0011. 101-M)420-000 Vs 00
CIO
C=)
CY'D
�W[I-TOTAL CONMIUCTIONAND PLAN CHECK
S333,60
LESS -P& 1�.Pmn �'F -11,
$0.00
U 1-4 11MAMIT]IMS 1)(4,NOW
RECEIPT
DAJE�
By
, �oe77
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
Electric Bond
Footings
Main Drain Juil z
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIbg. 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 z _,0 oo
Sewer Connection
Encapsulation
Gas Piping
1/ 7,
Gas Test
f
Appliances
.4
Final 00'
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power P61e
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)
l
Tv DEPA Td!.
CMDLSj�@ � r LLY
iEDF R w,4-TRH rum �"0
iT `u'l M"7 1k11t9 PER
i
-T—
AIND ALL APPLICABLE CODES
ATE BY
APPROVED'
A -CUSTOM DbION FOR-.
_ Designers $ Builder
e s Since 1958
73.555 Highway 1111,IienSen's Shoppirig 0eriter
Palm Desert, Call#ornia 92260
619-346-6i_15
_ Sta#License 053.238947
iCCUGRRPHIGS R@ORDEA N4. ASri 91 fS - - -
Imo'
1�J .�f III
SPECIFICATIONS -
,Si;r �,� VOlurne —rs 41101
TemPlalr Nu
Dap4hl heln,mum riAa.imum Break
a
SW Sale—VatiJFne range
� � E5ECn1rAT10K1 ----'-----
Finish Elrr+rlar,`� Jwlethtx7 (!;•u. Y 4.�-.
Accra.rattanL=--
p,rt Remaral •Loads to D.inIp
bey Well Localiart - r, _ - `•
Fence RemOycd 9,
5r4t pT Opening
NOTE Fla Parnting a mlTCr Ingo[ [axturrMnu h4 donel
PLUMBING � •- ------..
F.rrei Typt 1- .' •....—�-
Pump Type Site r if '
5krmi-nar Typerrr_� _- Si:■ -
Fi*star ryPG.-�
Nralar Venr Hy -
JrT Purnp Typ Size -_
Bltwm r T Vpr- _ . ,_.�-.�-. -_ T . Site
iquipmem Lncatian. r_' • _ P+CSlrlslPli �r� �-
Plumd2ng Matey-
.F{IChon 5iaa Length FT. dlschalge S,aa LC[h - Fele•
44ette Tom----_ _ - Srlr + - l,envth _ . __ Frer
Returns Ia Pool Number _ _Slee F �Lengrth _ ____ Fitt
Ralurn Inlet Type t _ _
Fill Line IWFth Qd 7r Ft. fVS Vilyr L �anpn,
Gas Line ey-yr - r _Sere Ut%th Fell.
+4Lrt4rrtatlC Cleanir}g __, -. _ -
v SPA INFORMATION �P
karlan. Site-Lgthr- Fl. -w.04 d g-& Lath Feet
Jdl Type--- •`•' NUrnbei-
Jet Are Lir1e Nursvbv Stu � • LaingTh Peri
91oweF Return Srta LegM Feet
SetrcTor Velvr: TyPr Site. -
Fill& Type , —Size _
Pump Type 5i3a
Skimmer Fvtx�-
r'ieeter Irypp Size �-- -�
Nearer Vtnt By
Jet Pump Type_
91Dim Tyne w - Size -
EqulPanenT LoCatlad, � P{G SlehlpeT r -
Plumbingltletetlal
Suction; SIJe Length_ FT. Diswhrrgr $lie— Lpm -�Foal
Waste To_ --. -- - $rla. LanSM Feel
Returns in Pool NumGer - _ Srae Length Feet
ReTurn Inlet Type
Fell Lrnr IWIth No 0WIP-GlIonr 151xa-,J,gIH. _— Ft. A1S Val,a Location.
Gas Lma By --- Slta . __ _-.. Lerlyth . _ _- - Feet-
Awtomatic Cleinrng
STEEL i
` jlim* Bond Beam E•' _.. l?" - - 1 B':r +GFhOrrt�
Spa Darr} Will. _- -. Frei
GUNITE !3
Cqr nor nadir � ets __ 7 -_Jell
51EPs -._ - F•II Lme Locallon
G,altr ��i "4dRai I CupAnchpi- --.-
$pd tnldrrriaTron
l+ � VLE AND G
? COPIN
Tiu 7_- .- Color -f�i5fT5 Cnplrtprp[ne+-�
Tnm. .- -•��-.-.Nwmberd Tile
SRtcral Datail See"STEEL•', "GO N11TE"
''•��' ELECTRICAL
By ' 4s C'i Light _.Cad LanmSh ,.-- Feet.
"J" Bat LOcairon 9-vnccn LaealWn- _
Kiliee Run-Fl Jer Elan . _ , Fl Lgrtt Awn _ �_ FeaL
Switch RWn _ Ft PjnriChange-
5Pa 9erliCt+ Location
r+aater Switch Lafatior5
am ���,o 6
-
bw LLF'nlo Fs. •5
Colo, --
` Ftad Anchors _
Filters_ ---__-Fi Expansion:- �w _
Standards-
040 Cl`rdlrL —
PLASTER
Lights Name Plates - ,�2C- Re}Gepe¢saps
GuG+4ncixw}Rul Anchgrt lr r• Cril45�
DATE:
SCALE ALDWIV.
NAME
ADDRESS
CITY L--A QUI-7A
PHONE
AREA?L}!`T' k
CHL X. BY ~ I
SHEET OF
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