RPL (0008-003)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (comrr�►,ncing 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 ,-
77601 per} C53 f ,0,413E �?�
Signature of Contractor
Dates;�' �`�
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).
( ) 1, 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.
( ) I 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 .XL?
Mpl,I014 Oe7 pI3..p 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_ l e
workers' compensation laws of California, and agree'that'if-l'should become
subject to the workers' compensation provisions -df Section 3700 of the Labor
Code, I shall forthwith comply with those provi§ions:e
`Xate.d' 1 glOApplicant •J !�': �.' 'r /� ' �✓��l - -
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.
1• 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 repre!?nt9ves of this.City to enter upon
the above-mentioned property for i spectio�purpo� ses
Signature (Owner/Agent) Date`��'
BUILDING PERMIT PERMIT#
P TE VALUATION 0008-'003 TRACT
�.y�} �o�LOT
tpLV �IOf�eL!Ol
-
JOB SITE
APN
ADDRESS 49-_W WISSION RIR'ST
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PIMTAIM A HAAS
CAL -WE V DOOM INC:
49.580 MIS 31014 DIME, WF -0P
70.180 THUNDER ROAD 03
LAQ'CI.iTi A CA 92233
RANCROM AOE
CA 92270
(760)831.0860
Mif
3735
USE OF PERMIT
POOL ANDIOR, ;SPA
POOL di:SPA ONLY.,ALARibiWARIZIER5 SHALL til£ I'M PLACE Ail
PR&PLSTER INSPECT !OK THIS PEWIT DO.F0 NOT INCLUD K-OCK
WALL FOR. FQUIPMI? NT LOCAT1014.
POOL l NDIOR SPA 24,000 00 U. '
FSi1,24A:14,'I'ED COST O3' CONYMUMON
:�•:40W.00 .
1..�
?"i I
PLAN CHEC'•!b ME 101.000.439.318 $157.95
C 014STRUCTIOA F14- 3 101-000-419-000 a9f.00•
.-"
IVlI:CkiA13ICP�L FEE -- POOL 101.000-421.000 $24,00
ELECTRICAL ITM -.'POOL 101-000-420-000 $45.00
��•
} �
PLLiMOl• O FEE •- POOL 101 -000-419-000
STUB-TCiTN, CON .tom. UC11ON AND PLAN f7"ti , fi:K
$496.03
IX33 PRE -PAW FL�,h;�
$0.00
TOTAL FKWITI!'iMES DUE
S49605
r
tRECEIPT
DATE
DATE FINAL9D
INSPECTZA�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
tiab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O+: 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
steel
POOLS - SPAS
Set Backs
Electric Bond
-"
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
/O-• OV
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
_ fit/
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:
O
T
Y "OF
L
A
Q
U
'
N
T
A
BUILDING & SAFETY DEP
T
.
APPROVED
FOR CONSTRUCTION
EEBy]
DAT
A
RE -INSPECTION f EE OF $30
WILL BE CHARGED IF THE APPOVED
PLANS AND JOB CARD ARE NOT ON
THE SITE fOR A 3CHOULED
INSPECTION.
Y
APTION
S�
-
.NO EX
CAL-NEV INC.
POOLS
Mark V. Touw
70180 Thunder Rd.
Rancho Mirage. California 92270
760-770-5853
?601 'cell phone; 760"831-0860
. N i
des/C- 7 /-1 e.
k 12- It
3
OWNER to fem pW area &W Woo so *=V vW seff 19rilig " per code.
NOTE: No dirt will be mmlvleed, reWmed or gmded em day of mmaftL
7
NOTE: Rdocatim of squormt pad wN m* In MMOW cod to ewer.
NOTE: Fig pool bnmadWt* 9W PMSW (tallow hWucbm00 W use rubber hose.
NOTE.
,of
Do not tum on pool "when pool Is m".
NOM Wet. down come shell 9 Wo twice d*yfor srm dWsAft 3W is kist".
I Irapa reviewed this plan and hereby Wvm total Plan & &Pwftftm
Un CUSTOMMSOL9W
PLU
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800vor Pump PO
MWn Drain 140
RK_
F3 Lim R L) TO
A.W Cb— - IV A V I
Htrjj @j::E�ALb Stas _4D�1�
Gas I)F 3 0
FOUNTM"PRAY HOO—WATER EFFECTS
lvpiL - -
Stas
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DRAWN
Booster vesft Tym_�___
Sim—
STEEL GUNITE
6'p—. 1F
24*
sm Wal Wk"Ift
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Notch ��
ELECTRIC- TOW Run L/F 3 FAwrop*—
P_ 5 Sp_LLL LJ —, 'rO At
stop a .11111111st
nECWM S4 R g cl Type
D.dPAR— SUP Risers L=
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Step___2�__ LWILL-_
1z
IXTIAW FINISH C L' (-w 6111 coilw2in1
OWNER, Pth L
CITYh SOLD BY_/e,-
DATE b-! L,
PHONE (H
-2� BY e22V
DRAWN
DATE/2114/,01'