RPL (0210-086)LICENSED CONTRACTOR DECLARATION f r t
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.
License # Lic. Class e : 'Exp: Date '` `::rr`
"Date �ti ' '�- �` Signature of Contractor
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
N , f 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.
( 1 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 EXEMPT 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 p ovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those,provisibns.
"'Date: kk; iz . �'? Applicant-
Warning:
pplicant-Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal, p* and civil fines up to $100,000, in
`addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety;
for a permit subject to the conditions and restrictions set forth on h•s
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&hold harmless the Cityaof La Quinta, its officers, agents and employees.
2. Any permit issued as af result of this application becomes null and void if
Work is not commencedwithin •180 days from date of issuance of such
permit, or cessation of -work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to.enter upon
the above-mentioned property for inspection purposes.
t
Signature (Owner/Agent) �� =' �'-r'i"- " '-�Date�' r` Q`l'
y
' BUILDING PERMT.`-IPERMITtN y,
DATE VALUATION LOT TRACT
010W.Al iJOB
1.
SITE
ADDRESS, _ r sw� (� T�. ��pl`
APN N
OWNER
CONTRACTOR/DESIGNER/EN (NEER
DDM POWF..; S
DIAMOND POOLZ :AND SPAS'
VION :C�1�.�.E �'ra°��'.!.•ff
7?+_y,�0p'0 �Sp,P,I:�+S�IcY�+y`•Ly`F•s`) J: p�'�U�s 9`f�t�'C.t7[?��
•'
IA�5*0y•,'�4��.pp'�1�.1��•O
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Ie{'.1. \YVd,CPA�A 1. A 9225.1
4
1�1'�tY NII DEM. Ir CIA '9221 1
USE O��^^F//PERMIT
}j���'(''�//'1�$g
PV01, CJND ldR 2VA
TOCOL,, SPA, S#Q, (ANSI Z21.53-1495).•AL•-.3tVS/BJ1 rjU.i 1U SHALL 13 It
IN Pi:ACR AA "RE PT AO T E MISi�T?C'-T.10K ZOUI ;YNT ENCLOSURE NOT
rNICL4.Mt)
%4:
FOO1. AN'I IOM SPA, 1..43
:PIMDAVYEE SOMMARY
PIAN CHECK 312 103 000.44 9.3.18 S1 184193
=14S'b RUC'r"". h'ON WE 101-000-418-000 0-41$••CJ00 VF O
AQEC:la.ANIV,/'a.L P'Li8 •� P001a 101.000.421.000
1?UC'1 RUC AL KIM — POOL 10.1.000-420••000 �fR 5.00
P1F19Mi3l O RE - POOL, l of -QC -41 q„ 000
y
711 ZEST
OCT 1 1 2002 CITALi#affr M,3 11"" NOW
CITY OF LA QUINTA
j
FINANCE DEPT
RECEIPT+
DATE J
BY ":
DATE FINALED
INSPECTOR
7
IF.m
.e. "
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
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
1
Gas Piping
Gas Test
Appliances
Final
r -
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)
13
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-7Gl. � A. M•tSS(CA. Dp-k-�F— CITY OF LA QUINTA SUB -CONTRACTOR L T
JOB ADDRESS -.PERMIT NULAEIER OWNER �` Ic'. 7�. BUILDERThis form shaill bit poslpd an lita lob with the Ittild111911111JUM122 ma In a cons -nim place.-
Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commenoement of work. F will re t In e a ape of work and/or the voidance
of
building permit. For each aeglicable trade, all information requested below must be completed agglicant. n File° isnot an eco able re nse.
•• • • wd...w _wa-r..�M in�d.rner tlM eta�tne L�rnf
Trade I c&WM= on-
Compsmr Nem*
Ctassilloidl n ,
(e.g. A. IL C-8)
Limse Number
IxaldurM)
Em. Date
laxixahxl
Carder Name
(e.g. State Rind, CdCeap)
Pollay Numbs
(Format varies)
EXP. Date
lax/xalntl
Llaeme Number
Oman)
Exp. Date
laXJXRAI l
eARTlMORK 1692i
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'7 17
11-30.o's
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NABONRY (6285 i\lltptK�1 I l.. CL y1 551'2.1 rSD 12
PLUNIING (C -M
LATH. PL40M 10-761
1
C 35
WAqq--;5
VAff;Doo q6L
11,03
DRYWALL (C-91
HVAC IC -201
13PCTRLCAL IC -101
ROOPINA (0.891 •,
,
SHOT YEML (C-Ul
FL.00RINO IC -16)
OLAZIIIO IC -171
WBOLATIM IC -M
SEWAtt6 OIV, (642)
PAINTING (0.981
CERAWC TLE (C-64)
CAMNETS (C•e)
FMCINO (0.1b)
LAIiDSCARNG (0.271
POOL 6631
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CITY,OF LA QUINTA
BUILDING & SAFETY DEPT.
4 APPROVED
FOR C NSTRUCTION OLF GOUR5 AIR■
t�tCk{o LA �u 1t�
02 BY l � + � � ..iD ■ f "
DAA !/
BOULOER WATERT°ALL AT +90' /0 — Z
'`ROS WITH TWD THREE aic'lu-myq, S
BOULOM, TO Bi: SELECTED
IR
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SPILLWAY
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AND *" VMtnGPAL
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POOL
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