RPL (9710-015)LICENSED CONTRACTOR DECLARATION
thereby 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.
LicBnc'? # Lic. Class Exp. Date
ate Signature of Contra --
OWN ER-BUILDER'
ontracoOWNER-BUILDER ECLARATION
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.
O„I have and will maintain workers' compensation insurance, as required by
Sec ion 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:
Cartier Policy No.
trr FSI vpt R 111 }A, 1
itiA.
(This section need not be completed if the permit valuation is for $100.00 or less).
KI 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
ode, I shall forthwith comply with those provisions
Date: rT 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
linnature
above-mentioned property fo�spection purposes.
(Owner/Agent) 41.�L;' , '�� ' - - 4 "Date ;
CONTROL#
BUILDING PERMIT PERMITy#3�f�-fly
3
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DATE VALUATION.1� �ti LOT TRACT
0 C7
ADDRESS 44l-_'%0 f1ULLr GO
APN
OWNER
CONTRACTOR / DESIGNERENGINEER
A (Q
{/
yr ,n Y. M..1ii i 110C,1l.. ay1.o iTlk
44,303 NALAW
4 741 V I'A.LKI CAN YON DR, ,,A.16
#:r10 ,01KI-A CA U27';' i
i'AIM SPRINGS CA 4Pt)=1
t~RLP .'%os
USE OF PERMIT
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f(frAl, A;'Cltl<114 W41;44 101V NOW
4sJt>ti3.. E►
OCT 10 1997
RECEIPT
DATE t,
By
DATE FINALED
INSPECTOR
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
BLOCKWALL APPROVALS
POOLS - SPAS
Stee6>
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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:
t
a
• �' SPA & R.B.B. +18" 3.00'
8' S.S. "CUSTOM CASCADES
\ 3.5' WATER FEATURE 3.5
32.00'
MOVE A/C 13.00' '
AROUND CORNER STRI PED 5'
J -BOX
& TI ED 4.00'.
4.00'
STANDARD
LAQUINTA(QUINTERRA) 4.0
ONE TRIP
ELECTRIC VALVES &
OVERRIDES FOR FUTURE
REMOTE
FEATURE RETURN W/JANDY VALVE
OPTION FOR SEPARATE PUMP FOR FEATURE
VALLEY POOL 'A SPA
SCALE 1 /8' = 1' t
LANNING RESIDENCE
LAQUINTA,CA
4156o M I LAGO
.CITY ®F LA QUIN.TA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
I o BY
20.00'
all
NOV l'ti,�% A, ,A2 s
J:
i
CONTRACTOR VALLEY POOL & SPA ADDRESS 4741 C E. PALM CANYON OR N 1 16,
OWNER LANNING JOS ADDREW 44560 MILAGO
This form shall he RaxMd on the lab with the Building Insoaudan Card at a8 rimes In a carlapicuous g ace.
It is the responsibility of the General Contractor or the OwnerfBuilder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La Quinta Department of Building & Safety gda to work being performed by a Changed sub-
contractor. Failure to comply will result in a stoppage of work end/or the voidance of building permit.
TRADE
8U9CONIRACTOR'8
NAME
TYPE:OF
8iA7EUAINIMS
iNJNBEA.
.::IEV.
LKi18E:.
DATE:W. ..: ,
GRADE/
EXCAVATE
AF y
A/C-12
611320
1769
PIPELINES
C-34
CONCRIEM
F�ATONS
- O��
C.8
1
8 Z 4-
K
3r
ASPHALT
A
FRAMING
8
STEW
STRUCTURAL
C-51
MASONRY
C-29
PLUMING
GATT USO POOL
C-38
6 7 2 8 5 0
8 1 6 A
LATHING
C-26
DRYWALL
C-9
PLASTERING
S.K. BELDEN
C-36
628102
4349
HVAC
C-20'
ELE(GAL
wwdl
ATTUSO POOL
C-10
6 7 2 8 5 0
81 GA
ROOFING
C-39
-
5HEEI NETAL
C-43
FLOORING
C-15
GLASS/
GLAZING
C-17
INSULATION
C-2
SEWAGE DISP.
C-42
PAINTING/
DECORATING
C-33
111E
S.K. BELDEN
C-54
.672850
816A
CAMNETS/
O TALLATION
C-6
FENCUIKN
C-13
LANDSCAPING
C-27
POOLS
C-53
OTHER
J 6 L GVNirE
472187
794A
f f3l 9.1e"T.