0008-365 (COMB),r
s� 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.
Lice e # Lic. Class Exp. Date
C r3 ,'! �1lonic
Date < ! `"� Signature of Contractor`.,Q. 4
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.
x) 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 issued. My workers' compensation insurance Carrier & policy no. are:
Carrier Policy No.
SPATE FUND 1$16532-00
(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
subje,�t to the workers' compensation provisions of Section 3700 of the Labor
Co?, I shall foliwith comply with:those provisions:
ate: / ila ePJ APPlicant..y;7/ 'd'� r.- 71,5 ,L _
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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 f6r'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 hove -mentioned property for inspection purposes.
,�' 6 1. :°L-
Signature (Owner/Agent) ""d r Date
- .. .
BUILDING PERMIT PERMITN
DATEVALUATION LOT 00s-30 TRACT
JOB SITE
ADDRESS
APN
'19-42.. AVEMDA 02CRE001(f
- -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
K8L P.R8 RT RESORTS ft4C
C.AiZ'C):Et.AI A POOU &I X AS
49-4 99 R-WE14919WER DR
74.725 JOM D.RTVE� AA
LAQT ItTfA CA 92253
P.A124DESE r CA 92260
(760)341.9000 CB1.4 5396
USE OF PERMIT
REMO'KATION OF TEN'N13 C1.,U8 POOL COMPL IM RELOCATE SQA; ADD'
FIREPLAC:.C, WAD11140K)041417W POOL EQUIP, MISC WATER F1%.:l,9'I1RiA
WROUGHT IR014 M-Itr IC MISCISLECTRMA1.
VALUATION 400,000.00 LS
PERM111 rkv SaaMA"Ry
'PIAN CHECK ME 101-000-4319-318 $1,202.00
COI*f:;"1'IiUC.'9'1C.i1*1' me 101-000-4418-000 $1,669.30
ELL-TRICAL FEE 101-000-420.000
PLUMBING YZE 101>000_419_000
STl ONO MOTION FEE - RE8XD 10'l A000.24'1.000 S40,0t1
MECH ANIC..AL .M, — POUL 101-000-4,21-000 $48.00
KIdECTRACA1 PER -•• POOL 101-000-420-000 613400
P.L•UA4BINO FEE - POOL 101-.00l-019-000 01.'30
SUB-TUYAL CON9YRIM-MOM AMID P.aAM ar c
$3,201.50
LFZ3 1`'M— PAID FnN.
$0.00
Tom. 1 1.&171' S.DUE NOW
53,201 J
01C i ;y
RECEIPT w
Al/
BY�/
DATE FINALED
INSPECTOR
t
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
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)
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COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
District Environmental Services Division
POOL AND SPA PLAN CORRECTION .
District No. Plan No. Date
PROJECT NAME Qty t(�\lam i,elnw 1� ��SW , Vn ef'r~
PROJECT LOCATION qej-," (N 2r' , L . V� •` e.'
OWNER /CONTRACTOR KS
The plans are now approved subject to the conditions liistedt below.
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CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections at least three (3)
working days in advance.
A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment, and signs.
APPROVAL to operate shall not be granted_ until the facility has passed the FINAL INSPECTIONS and 'APPLICATION TO
OPERATE" has been completed and PERMIT.fees have been paid.
REQUEST FOR FINAL INSPECTION SHOULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
Plan Check By N1 1 k_ Phone
I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them_ during construction::
4l
Signature
Company (� A CI.FUr1 Allo 000c".S- .
Date g-/3 -o o•
DOH -SAN -181 (Rev 11/95) Distribution: WHITE—Office; CANARY—Applicant; PINK—Bldg. Dept.
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1 DEPARTMENT OF ENVIRONMENTAL HEALTH,
_' ENVIRONMENTAL HEALTH SERVICES y
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SUPPLEMENTAL REPORT TO SAN., F063_A(I..# �'(� � /l (p,����C`�,� tOGI. DATE
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,SUBJECT Ck l`.(� LA � N 7c l `Q'�y\ I .� � �W � � C-�`,�' . PERMIT NO.
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,: DEH•SAN•118,'(Rev2/66) Distribution: WHITE—Office; CANARY—Owner; PIN" ice