RPL (9710-160)LICENSED' CONTRACTOR DECLARATION
I hereby affirm under pt}nalty of perjury that I am licensed under provisions of
Chapter 9 (comes encing 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
238,0947 C-5?�.. t 3;1:11198
yt
Pate i - Signature of Contractor s11
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.
A 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 Policy No.
GOLDEN RAGLE 14WC38146102
(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: 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
& 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 ) in pection purposes.
Signature (Owner/AgentI f �/ OU'Al Date A /i
BUILDINGPERMIT PERMIT#CONNTTRCL##
=1 H
6162
DATE VALUATION LOT /_91—W-160 TRACT
JOB SITE
APN
ADDRESS
}
. (--`r�fgfip5-MEy���I�11�1�MN�
OWNER —
CONTRACTOR/DESIGNER/ENGINEER
DEANE.HOMES
MASn.R POOLS
78-875 MERIDIAN
73-5551410HWAT 111.
LA QUINTt1 CA 92253
PALM DESERT CA 92260
(619).34"115 CBL# 16
USE OF PERMIT
GC1f )1
POOI. ONLY
POOL ANIXOR SPA 12,800.00 LS
WSTIMA'TE0 COST OF CONSTRUCTIONi2,l31Nl.11i9
PERMIT FEE SUMMARY
PLAN C14PCii FFE 101-000-4139-3113 $43.60
CONS`rPWFC" PION FEE 101-000-418-(x10 $.144.00
MECHLANICAL.FEE -- POOL, 101.-000-421-000 $24.00
LX CTPUC:AL'Ff�` -- POOH. 101-000-420-000 S45A*
PLUXIAING FEE -- POOL .101-000-419-000 $217.00
n
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$333 011
LESS PRE -PAID FEES
lk 111
$0.w
TOTAL. PERMIT FEES DUE NOW
5333.60
OCT 2 7 1997 ,
IRECEIC �--r-\ f �p
,DAT • �%?�
BY
DATE FINALED
INSPECTOR
FA
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
F�•ms & Footings
Ducts
Swb 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
Final
Gas Piping 49
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 Y7
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)
Special Detail: See "SrEtL" " Gum r
ELECTRICAL
ey; �li tiLJ {Cord let�gsh Feet.
J" Box Location Switth Locatia'
Filter Run Ft. Jpet Run�,._Ft Light Run Fact
Switch Run F1�al Change
Spa Switch Location
Heater Switch Location .S
DECKING
By;' r1AQ'i G inish S+. Ft
Color I Cantilever -Rail Anchors
RisM Ft Expansion:
Standards:-Board/Slide ---
peck Drai
PLASTER
Lights ams Plates Recessed rept
Cup ArKfiors�aa Anchors Grills
- APPROVED.
BATE: ,
.. r
ACCLMAPMCS REORDER NO. A(34971S