9908-085 (POOL)r
LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
I: C I hereby affirm under penalty of perjury that I am licensed under provisions of sma IIISS
Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION LOT TRACT
04 W � Professionals Code,and my License is in full force and effect.
O :) c,) License# Lic.Class Exp.Date
I, E1`Ktc1�S } _. -'' yotol ADDRESS -JSP kUitlili/�F+ APN
Z ate i Signature of Contractor _ R OWNER CONTRACTOR/DESIGNER/ENGINEER
r` ~ � OWNER-BUILDER DECLARATION R7''•11.1-MES I.I,r• PJT 1;`,VEI.'kXIiEs,IINC.
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's PO BOX 10 142;E.LNIVERSITY DRIVE
~ U) License Law for the following reason: LA QUINf A CA 92253 PHOENIX AZ 85014
Z_ ( ) 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). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals K1+A,tl1+flJfi`K;SVR IIIIIIIIVIII II IIII 55
Code).
ce) () I am exempt under Section B&P.C.for this reason 110iiL&SPA ONLY-ALiU6f.`if1ioVk•iihR&SHALL FIE IN PLACE AT IE
LO
N Date Signature of Owner I:l2li-FLi'd,`3'I`iLlNilafit"x'!C)I�t
ON
Q WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
U') - O O 1 have and will maintain a certificate of consent to self-insure for workers' POOL ANINt c�-�A I0•000,000 LS
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
QU ) I have and will maintain workers'compensation insurance,as required by
Q U Q Se Ion 3700 of the Labor Code, for the performance of the work for which this
LID
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No. r' n ( t/+� ��
cb n ST AM i:Ci7� (33 ^i-i�J� Aw��13#:'x'+r::::t,�'I•OF ClYN.�Oily 1 ION �Vy�lV1i.YV
Q (This section need not be completed if the permit valuation is for$100.00 or less). MIM t KE SiFhiA ARV
O I certify that in the performance of the work for which this permit is issued, PLAN t_!•II;CK FE+' I(ii-(i(}(3-4_19•24lit $76.0
1 shall not employ any person in any manner so as to become subject to the riWITR 4 T,r 10 W VT-11r 1r})..(it'N)_d1A-f01 11'7tUi
workers' compensation laws of California, and agree that,-if I should become „ R , ,
3 subject to the workers'compensation provasions,of�Section'3700 of the Labor INVICfu�.1111CAi..5;1:- 1•)OL .a1•(Kt(i421,D00
Code,I shalefortthhwl�comply with those<� visions. uLl.tiPIRJ.QA1,FLL--!'L.r A, 101-t70�(.-42G-(>Od} 9tl�.�lU
Date:!' � / Applicant .."/ � *-- ^-~^ til l)l�f3sliYti F 1 t -•t N11. 1{)1.1 � !J f►��Ib $27,vi)
arning: 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 SIJB-7111'A1,CC.NIS li'ft.i 4710N AND PLAN(14117(19 f)1%
& hold harmless the City of La Quinta, its officers, agents and employees. i,ES� 1'R.2-PAID FEES 4110.00
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. 10T.Ai. PERMIT VVE—S DOE Now SZ89.05
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.
RECEIPT DATE BY j' DATE FINALED INSPECTOR
Signature (Owner/Agent)�! Dater
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
0.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 i
Underground Electric
Underground Plbg.Test I+
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
COMMENTS:
Final
Utility Notice(Gas)
ELECTRICAL APPROVALS
Temp.Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring _
Fixtures l�j �/ 1
Main Service
Sub Panels
Exterior Receptacles
G.F.I. G,LJ`C
Smoke Detectors
Temp.Use of Power
Final
Utility Notice(Perm)
04/30/2002 09:09 7605646505
' r; IIIIIIIIIIIIIIIIIIIIIIIII 56
c° � IE •
CITY OF LA OUINTA '
BUILDING &SAFE EpAPTMEj;-..,., �.�«��
INSPECTION REQUEST LINE
7774153 AUG 131999
S LLC
Owner •ItdT
r V `
Contractor
permit Number 908485
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-380 AZAHAR
}
POOL& SPA ONLY-ALARMS/BARRIERS
SHALL BE IN PLACE AT PRE PLASTER
TYPE OF INSPECTION DATE INSP.
FOUNDATION&SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-(3UNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNET)
CONCRETE SLAB
JOISTS&GIRDERS
ELECTRICAL GROUNDWORK
p„NOT POUR CONCRETE UNTIL AI-L ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 6 GAS TEST
HEATING&VENT-A/C
FIREPLACE y '
ROOF A
r Hr
BOND BEAM (
O.K. TO WRAP A `E0
d OUT 0 4' ❑
FRAMING
INSULATION
PRE-ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE&GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
nNG-A/C
,kUu E NUMBERS U !�
JOB COMPLETED
TEMP POWER ,
ALL CONCRETE FLAT WORK SHALL BE PLACED A
IMNIMUM OF 2" BELOW WEEP SCREEDS.