0404-020 (RPL)79765 Amalfi Dr
0404-020
• - T 2
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. T
License g6l ,ig Qgg(31ass,C,$ Exp. Dame 1 /(k
Date ,Signature of Contractor 41"
f •
1'10 VV
r 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).
( ) 1, 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
permlt'IsN p,& K
CM,,,y1Vpr
ft,s4c,oppensation insurance eawie+yl&gpolicyt no. are:
Cartier Policy No.
(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 those provisions.
Date: f Applicant—
Warning:
pplicant Warning: allure to secure Wo ersL° ompens tion 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 property for inspection purposes.
Signature (Owner/Agent) ` - Dates
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PERMI= #I .
B," ING, PERMIT
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' DATE" F ION LOT TRACT
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OWNER ^"
PONMOSA.14OW811 NC
CONTRACTOR / DESIGNER / ENGINEER
C;A11F'vitATs`.APOOLS SPAS (VIT) MAM CO3
400 S, Y.gRR MI:DR ia'CTUEB 103
gt,,.10Q AVT, -I OF 54
PRIM ; RI 7'Css C.A. 92262
COAMO Lam. e•2 i
060)398-9222 C -ST- € oo355
USEOF P V]Wwak ` t
POOL AND SPA.. 3 LF Y r3LOC"IK W*LL CITY S'
NI). ALARNIS1B1tf2I2JERS
SHALL BE i.N PLACE PRIOR, TO PREPL &SU.R INSPECTION,—
IIIIIIIIVIIIIIIVIIIIIII 48
IE
POOL ANDIOR ;IPA 101,000.00 1.5
5 VP. WALL :5.0 LF
ES'1LPlUMD COST OF CO ZY)NI ILMON
X 7,108. -
ULAN C. 1 K FEE- 101.000.439.318 $122,85
CUNS'I'RUCTION FVIv 101-000-418-000 $If39.00
MECLV.;lilCAL FEE -- POOL 101-000-421-000 $24.00
LrtAC;TRICAL FES •- POOL 102-000-1120-000 $45.00
PL,UMBINO INE -- T100L 101.000.419.000 92U0
8TJB,';l Y1.A3. CONSTRUOT ON AN"3yYP'Z. {- i Gry 3Mp ggC
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APR 0 6 2004
CITY OF ILA QURITA
FINA&,-e I3EI✓
RECEIPT
I DATiE!
Y ! ^/
111o
DA 6{N-or
NSPE
l
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
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
sinal
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste! ^4s
Heater Final _
ing
Plumbing Final
Top Out
_
Equipment Enclosure
'ans
O.K for Finish Plaster
bf
Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
v!
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)