0011-091 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that,l am licensed dnde0provisions 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
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.
UI have;and will maintain workers' compensation insurance, as required by
Seion 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.
1' ILLIAMMURO 7?1+tlS. WC9 179A_01
(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 r.s 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 shell forvyith comply Ith those provi ions. ,,;"�
Dated// Applicant �"/�^ - �S�ri s- --. •..W..� t w
V-^
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 propel Wor inspection purposes.
Signature (Owner/Agent) - /^---��" --"'`� Date
BUILDING PERMIT PERM'T# .
.t
DATE VALUATION LOT $,-�Cjiy TRACT
,
JOB SITE
ADDRESS
4.1X464 1/2 AVH'XJ' )A ODREGON
_
OWNER
CONTRACTOR /DESIGNER / EN INFER
101,
MCI'13r , POOLS SPAS
55.92U PGA D
PI O, BOX 11791
Uk QiJiNTA C-. 92253
LA QUX1A CA
92253
�1601360•-3.583 CrBL'
1945
USE OF PERMIT
POOL A3 DAY'R OPA
C`'YMERC'1A1., POOL a PHASE 4 - I AND CAP LIYT MUST BE PRF.3F.N1T
FOR. VefflAt - L111'r SI..fiVIZ A:l' SRA KND POOL COL`1k.`! D
1'0011 A14I1'T110A SPA I,S
'
.F. SIDIM ED COST -OF COAMMUC, f1014
PLAN CHECK M 101,-00ID-439.31€3 $4P..A,93
C 014S7`Ri.lCTION 1' ZZ 101-000-4 A 8-000 $294.50
PstEC'•IAINIC:AL FEE -- Pk)'0 101.000.421.000 $24,40
3+LF.;C'f 1U AL FEE —L 101-000-420-000 i�IS.tiU
'I.,1bMBINO MA -- POOL � 101-000-419-000 00-419-000 MIN
;
0ALV
2001
JAN 18
-TOTAL CCyhy'SA' UCT[ON A14D PLA14 CHRIM,
$565.43
w Lros Pn"D mms
$0.00 ,
TMAL F t VTT%S V13E NOW
45*65.45
RECEIPT
DATE (j
BY�
DATE FINALED
INSPECTOR
I J J>� LS
JI ,Y`
l
.
Y"
]
1
I
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings i
'Slab Grade
Steel
Roof Deck J
O.K. to Wrap I
Framing '
Insulation
Fireplace P.L. I
Fireplace T.O. ]
Party Wall Insulation
Party Wall Firewall I
Exterior Lath J
Drywall - Int. Lath I
'I
3
Final
BLOCKWALL APPROVALS
Set Backs !
'Footings ]
Bond Beam ]
l
I
Final
PLUMBING APPROVALS
Waste Lines
Water Piping ;
Plumbing Top Out I _
Shower Pans ]
Sewer Lateral
I Final
ELECTRICAL APPROVALS
Temp. Power Pole ]
Underground Conduit
Rough Wiring I
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I. J
Smoke Detectors J
Temp. Use of Power
I
Final ]
Utility Notice (Perm)
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air "
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. T4
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaste
Pool Cover
Encapsulation
Final
COMMENTS:
POOLS - SPAS
JNTY OF.RIVERSIDE HEALTH .SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH:
District Environmental, Services Division
POOL AND SPA.PLAN 'CORRECTION
District No. �- Z Plan. No. Date 76-0 0O
1
PROJECT NAME L U QA i';n � P.��r ( 1�0/Yl f -
PROJECT LOCATION t/ I Ue/��i — y ,r�(" n� �. Q
OWNER / CONTRACTOR &
The plans are now approved subject to the conditions listed below. L
l a r Q if / 000/Y Y o yrtT (r C. i K r o t- o i
S k J.V,A JAN pws r c c% Pa<:� n (i2 t .�� -SlC. Vo 11,A n tis �-o r,.lra (� d UA /v(,&n r�c w�►vr�
i U n
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6 S ( C+.
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dc <.. W1 vd .,(' i^. C l 0 r� . o
ONSTRUCTION INSPECTIONS: Cocntact 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 4, lity:has passed the FINAL INSPECTIONS and "APPLICATION TO
OPERATE" has been completed and PERMIT fees have been paid.
REQUEST FOR FINAL. INSPECTION HOULD BE MADE AT LEAST FIVE (5) WORKING -DAYS IN ADVANCE.
Plan Check By KJ, - Phone. ( ) iv_' 12 3`r %
c
I acknowledge the corrections noted/herein and as •ndicated.on the pl and agree to ' rporate them during construction:
Sighature -
Company
Date h l7
DOH -SAN -181 (Rev 11/95) Distribution:
EC EYE
OCT 0 6 2000
CITY OF LAQUINTA
"_PLANNING DEPARTMENT s.