0309-0206 (POOL)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
faS6]x8 C53..H 0 .1/24:
71 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
Seclif o 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 ;9PA'FF.0011+.I-
pZ1J3a1TI Policy No. i�4r5-f4Xb8•?003
(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 thos p ovisions.
Date: �-"9l .I Applicant N #,-w
jet+ ,,-
Warning: Failure to secure Workers' Compensation Xverage 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 attorhey'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 cancellatiom.l
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 f nspection purposes. .
,a
Signature (Owner/Agent) .+ .� a �� Date, a^
BUILDING PERMIT PERMIT #
DATE i VALUATION" LOT TRACT
�ry /��
L •. ; �7� $1 Y g .W
JOB SITE f
ADDRESS 49-M )WER:4FA COURT
APN
_
OWNER
'CONTRACTOR / DESIGNER / ENGINEER
%R'.9Vffl8' Y3O1rfWG ]NC
CALMORMA POOLS & SPAS pr3 p mfix co
9968MMF 7r hTWX 102
96.100 AVENUE 54
MW DIROb CA 92131
COACOZZMA CA, 92236
(761 )398.9222 CULL .0055
USE OF PERMIT
P001, AMM SrPA
POOL/SPA. ALARVISMAR.R ERS SHALL BE IN PLACM AT PR.R•PLASTM
WOIxP.CMON. 'R4Ut1'MM4T 9MCL OSURE NOT WCUA IMID ak
I'OObANDIOR SPA. 17,00.00 W
Er-97MAMM MW OF CONUMVCDOW
PERMT ME 4'n"Ry
PLAN CI•IECk ME 101-000-4-59-318 $117.00
CONSTRUC`[`IM FU 101-000-41.8-000 $180. 1
I ECHANIQ4LFEE--FOOL 101.000-47.1-000 $24.00
ELECTRICAL VFZ «> POOL 101A -000-420-000
PI,L1MINO--:SPOOL 101.060.41.9,,0 0 $d1,4►4b
,
SUB -TOTAL t"'ONS]'°. ITMON Alin P7. W f.EWUM
1 PRE-T1e U EE M
$0,00
D ?►, ' '_ &' :1117 ES Di7�o:.L NOW
� ��►.+�
SEP 2 5 2003
_
IIIIIIIIIIIDIIIVIIIIIII
27
CITYOVLAQUiNTA
_ IE _
RECEI Y
DATE FINALED
INSPECTO
Ra
INSPECTION RECORD
OPERATION
9
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
-3
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
"3L -- '�
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)
COMMENTS:
;
I
111111111111111 1 28
ITiff
P.O. Box 1504
LA QUINTA, CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
December 30, 2004
Mr. Matt Jimenez
49-820 Althea Court
La Quinta, CA
RE: Building Permit Extension Request
Dear Mr. Jimenez:
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
I have received your letter postmarked 12/24/04, requesting an extension for the
swimming pool being constructed at the above address under Building Permit
#0402-118.
Inspection status:
Pre-plastedencapsulation: 5/24/04
180 -day expiration date: 11/22/04
180 -day extension date: 5/23/05
Under the provisions of California Building Code Section 106.4.4, your request
is hereby granted.
Because the Building Code specifies that "no permit shall be extended more than
once," please be advised that unless the project passes its next required
inspection on or before Monday, May 23, 2005, your building permit will expire
automatically.
Yours truly,
AS a
Greg Butler
Building & Safety Manager