RPL (0009-068)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penaltye of perjury that I am licensed under provisions of
H '� Chapte-r 9 (commencing with Section 7000) of Division 3 of the Business and
_0, w, Professionals Code, and my License is in full force and effect.
O Z) rj License # Lic. Class Exp. Date
�y656128 C53 - i OJ `if2t
Date,"
IS.- 0<1Signature.of.Gontractot ' .> _ '` ^^ l `- ^"" •_
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).
O 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.
t (;O,rl have and will. maintain workers' compensation insurance, as -required by
r'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 STATE Zv'E7AD Policy No. 00-00-0006163-00
(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.
"bate f r7OApplicant 7 �✓ � • N
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 2i
application. t
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.
I Any permit issued as a result of this application becomes hull 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.
Signaturee (Owne"r/Agent)' - Date `' ! <: :au
- PERMIT # -
BUILDING PERMIT
DATE VALUATION LOTTRACT
a
JOB SITE
APN
ttr
ADDRESS 4 7 M OI T�.,ANWAY
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TD DESy;Ct DEV` PbO, 4T
t
CfisUFD.i KEA POOLS & SPAS
PO BOX 1716
74-725 JONI UIVE, 0.
L.A. Qui: arA CA 92253
PALM iDFSERT CA 9220-0
(760)340-9000, ORtO 355
USE OF PERMIT
POOL AND/CSR SPA
POOL &SPA. ONLYALAR1d1SIRARLRJERS SHALL OF, IN PLACE AT P119
PI.,ABTER TNgWT10N.P00L, EQUCP.M9NT ENCLO52UIM 18 NOT INCLUDED
T14 THIS PV MIT
POOL A.Nr,/ vE SPA � - 14500,00 L3
•F.
FSMMTFD COST OF C014SMUCTIO.N
1611500.00
FEN1V.i F 11TH Si77la!ilti/iARY
PLAN CHECK FEE 101-000.439.318 $117101)
CONS`R(ICTIONxZE 171.000.418-IrGo $1.90.00
1V[ CHANIC;.AL FEZ --POOL 101.000-421. *0 524.00
ELECTRICAL . EF, - POOL 101-000-420-000 .$45.00
PLUMBING FETE - POOL 101.000-419-000 $77.00
St7i3='!'OTA2 dC1`YS"l L �C'i'Si1ii� a�1hF1C71?' ,1J C iEC%
$393.00
LMS PJ2E-PAJJ.TD FIEVKS
$0.00
TOM PI.TeIMITFX S XTE JR OW
$391490
S3
RECEIPT
DATE
BY
DATE FINAL D
INSP C R
.
C/��
5k�
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
OX 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
Exterio- Lath
Drywal, - Int. Lath
-
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
�c
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
•!.G'
Underground Plbg. Test_.
Final
Gas Piping
e, ----
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
1,0—cc,
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
`