9804-098 (RPL)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
692059 C-53 7/31/98
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.
( ) 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.
CAL CONIP 0983136509
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) •1 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: ADolicant
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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Ahy•permit issued as a result of this application becomes null and void if
woZ k�,is not commenced within 180 days from date of issuance of such
i pe'�nir 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# CONTRO�Lg#
DATE VALUATION LOT 9804 Q r e -098 TRACT 6
$48,000.00 (�7 j _�J
JOB SITE 6 -
APN i
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RON SODER,L1NC
CAMILLA POOL CONSMUC` 10114, INC,
57-411 RIVIERA
'78-710 LA P.A:L'NIA I*_1R.,J a QIAWA.
LA. QU1NTA CA 92253
PALM DESERT CA 92241
(760)�i0-6602 CI L0 18+44
USE OF PERMIT
. f.
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POOLWA & l4A.TERFRATILTR , ALARMSIBARR.IERS ARE TO BE
OPF RATIONAL PRIOR TO EN -CAI' INSPEC.FTON PAW
Pip
171998
POOL AND/OR SPA 48,00.00 :LS
F GONNA
i+ STI'MA'!"ED COST Of. Ct N&&RUC' ITN
4t�.,U1F41.ti€I
PERINIff FEE SUMMARY
PLAN CRECK FEE 1014000-4-19-3.18 1$2610,98
CONSTRUCTIONFEE 101-000-118-000 &101.50
MECHANICAL FEE -- POOL 101-000-421-000 $24.00
ELECTRICAL FFF — K)OL 10.1-000-4.20-000 $45.00
PLIJN93ING FLT -. FOOL 101-000-419-000 327.0
SCB-TOTAL, CONSTRUCTION AND PLAN CHECK
$7158.48
LESS PRE -PAID FJU,S
TOTAL PERAMIT FEES .DUE INONV
$7:58.48
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond .2
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location s '
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
t
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Final
Utility Notice (Perm)
COMMENTS:
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HORTON
SHEPARDSON
ASSOCIATES
LANDSCAPE ARCHITECTURc
4? -575 Velania Place Sui'e S
Pal -n Desert CA 92211
Tel 619/341-1115
FAX 619/773 9215
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