RPL (9912-029)LICENSED CONTRACTOR DECLARATION
'.:,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 ExO. Date
.1 2S. I , l'�o
ate Signature of Contractor
OWNER-BUILDER DECLA ATION
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.
( 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 Policy No.
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(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
worker compensation laws of California, and agree that ikPshould become
subject to the workers' compensation provisions of Seotlon 3700 of the Labor
Cog e, I shall forthwith comply with those provislo s!0`�
ttD' te: I J l "r l 5 4 Applicant'—: °1Nor—T, �'-- �— •,
Warning: Failure to secure kers' 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
fora 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;110f this City to enter upon
th,,e�above-mentioned property for inspection purposes.
1,Signature (Owner/Agent) - Date
' BUILDING PERMIT PERMIT #
9912-029
DATE I2fV13j1;99VALUATION � .�yj(�lf;, `� LOT TRACT
JOB SITE
ADDRESS 79-4619 MISSION ORM, W811-?1'
APN _
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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.PCS BOX M6
744,125 JONI..`DIUVE #A
LA tVQ"LaiTA. CA �Yv5:3
PALM M;SERT C.A. 92 260
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USE OF PERMIT
�".,�tb{i�AC.Y� ttii.�:.� �'?i.iUl.. t� i�.lat•1. iii �fd:�' � i14.��3�c�a:�.9 �'ilf�:'L;t. ��: ��� h�2.N�.4.�`ti k�"� :
PXHAPL&STER INSP se.;:t°iON
POOL AM.,iOR STA i.:, IRM.00 L
Cr 1p"'Y OV Co— MINI'[!.. At .J
K-00
V%AN 04ECK FE
N1 Cid!`vN3r'E1"i. e i'r . POOL. 'Ltd? ttt >- i , r°i(iij 324.Ori
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SUB-.`i7C 1114:OA? ij RIJI,71'ZP.lIV. M(l PLAN C"HF,r
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RECEIPT
DATE
BY
DATE FINALED l
INSPECT0
INSPECTION RECORD r
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
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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:
City o La Uinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
a ter approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Community Pool at
79-060 Mission Drive West Rancho La Quinta
Applicant Contact: Nolan Sparks, Sparks Construction, 771-1941
California Pool 354 9000
Application / Circulation Date:
Community Development Department
Christine di.Iorio,
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Mark Harold, Building and Safety Department Manager
Health Department
Fire Department
Schools Fees Paid
L
Date
Date
Date
Date
Date
Date
Date
I
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
Y' District Environmental Services Division
POOL AND SPA PLAN CORRECTION
District No. Plan No. Date ,S— /
PROJECT NAME
PROJECT LOCATION
OWNER / CONTRACTOR
The plans are now approved subject to the conditions listed below.
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CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections at least three (3)
working days in advance. - -
A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment, and signs.
APPROVAL to operate shall not be granted until the facility has passed the FINAL INSPECTIONS and "APPLICATION TO
OPERATE" has been completed and PERMIT fees have been paid.
REQUEST FOR FINAL INSPECTION /SHOULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
�-
Plan Check By G41; ,>�! �.:� _.t, k Phone P
I acknowledge the corrections noted herein and as indicated o e`e lans and agree to incorporate them during construction:
Signature
Company QKJ 19,PL S
Date S/19 /-?. 1
181 (Rev 11/95) Distribution: WHITE—Office: CANARY—Aoalicant: PINK—Bldo. Deot.
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