0002-0431 (POOL)LICENSED CONTRACTOR DECLARATION
rhe*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'
X59103 A C10 03/31/204
bDate ✓ 6%_ Signature of itractor
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 ryy Policy No.STAM 044-0019457
(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'%ompen sation laws of California, and agree that if I should become
subjeci to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those.provisions.
Aate: l . ,) f1 Eur, Applicant
Warning: Failure to secur W rrker�ompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this applicatioh is made & each person at
whose request and for whose benefit work is performed under or pursuant.to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work' is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agnt)� �---� ---^-^ Date00
PERMIT #
BUILDING PERMIT
09,Z-431
DATE OV29/20()VALUATION �� ��$�� LOT 54 TRACT
ADDRESSJOB SITE 43-615 AL EA COURT
OWNER
CONTRACTOR / DESIGNER / ENGINEER
A 1 �rn ��
/"'A�'UtiFi.�1'�isJ•, �1A'�t'9`t�CLI'
CAS ♦ s A hI 1 � .7 u.
7,St:'4l`117>�i�f�t"':f,�6�'r'1)'�ft""i"�t'y�0;i
ase..1. a...e •: ♦.L a a. � ", 1�..oe O .
43-6I5 ALBtt c.oJR r
6MO5 PEREZ ROAD, SGITE 1~-30
L.A, QjJ111a'A CA 92253
CATHEDRAL Crll' CA. 92231
(760) CRL# 250
52,
USE OF PERMIT
POOL ANDOR. SPA
Vii.. AND 7t n uWLJ'-1\i,,,RMSr13A11Ri`fs%a IHAi.1...esE.1N PLACS AT
Nth%-NLAS'1'. R INSPEC'VON
POOL iWYO% S- 17A i"o,;t�0,00 rAN
COST OF �.". NS�i''sayw3010N
'Syz 3� t�g�g2�,� ,�.�"a)�i'.`iB�:I'��rn"IMD
.F'E39�,7f�11,�. FR..E r=4U1.BgiYMtAR],-
PLAN CHECK FFE 101-000-4-19-318 $128.7f)
CON-81`I"e.K110NFEE 101-000-419-t3MO ;tcre_hn
010
1U EC"IRTe,AL rilb -- POOL 161-000-420-000 345.00
PLUi 4W.N0 FEE -- POOL 101-000-41 9-000
c t�
a
aZ1,Y--'IYK3'1't�1 CC�NS'!titt,IC11ON AND PLAN C'7�r1
X422 70
1, EM PRE-PAIDHIES
$0,00
TOTAL PRrk'sJA'Yff FEM D611f'J NOW
S422.70
63
.ifdv
IE
RECEIPT
DATE
BYE —✓
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
t7
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/Z—tTC�
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)
"
�• F- r�� a q.
IAYi //rig nnr
-
--- y•x 3�
�46 cc oFIFA 0
cbe -11A u1sl^ flooke f)
N A'gE-INSPECTION FEE OF $30
b N;'ILL BE CHARGED IF THE APPROVED
PLANS AND 10B CARD ARE NOT ON
THE SiTE FOR A SCHEDULED
INSFECTInk
NO '7 CEPTIONS!
0t4-
\ S
c_
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE BY
G -As 'E: e l e c /7 o' to -
e9 AI eMe•Cr LM't-hoA,
It�
t f-,a'ky1 e400,000 t( y-, t0
G� P 1 K IVAYw111O