0403-316 (RPL)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. I oI
License #-- Lic. Class � Exp. Date
Baa ,..,� ��� f!�i
Date 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, wilk.clo 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 prdject (Sec. 7044, Business & Professionals
Code).
() .I am exempt under Section B&PC. 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 iVsseed. �fj/�ykw`orkers' compensation insurance C?r . y& (policy no. are:
Carrier 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 d�Il should become
subject 0therwerkefs' compensation'provisionsof Section�3700 of the Labor
Code, I shall forthwith comply with those provisions'
Date: 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 authori2e/represeritatives of this City to enter upon
the above-mentioned prorpe�yifor inspection purposes.
Signature (Owner/Agent)) Date
BUILDING PERMIT
DATE _VALUATION LOT
JOB SITE
ADDRESS
AVEMIX
PERMIT #
0403-116
TRACT
APN -
OWNER CONTRACTOR / DESIGNER / ENGINEER
ALDIMErt, POOLS H, INC.
44-365,M01Tf1C.M,0 4,1625 ECLFWTIC WAY 91x lid
LA CS-JR-4TA CA 92253 PA-L-r2.DESERT CA 412260
1 (760)773-24293 CMUII 5302
USE 7P34T,Ti' in)/m . Jii
P.REPLA,STER 1145 ECTION,
POOL .9N OR SERA
23 009, 00 L i
ESTIMATED COST OF COMIMUC11,10N
FEMME YUSUMMARY
PLAN CHECK FEE
103-000-439.316
WIN
COMSTRUCTION FEL?
101-000.418-000
$357.60
MIECULAVICAL FEE -- POOL
101-000421.000
024,00
E=_TR1CJUL nE -• PORL
1024) 0-420-000
$45.00
PLUMBING rR E .- POOL
101-000-419-000
177.00
CrJN:'1'RU AVOW AND PLAW COICK
U BAR 2 9 2004 In
CITE' OF LA QUINTA
FINANCE DEPT.
RECEIPT DNTE `7 t �t BY \` DATE FINALED INSPECTOR
$511.110
$0.00
$531 IN
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
steel
POOLS - SPAS
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
Electrics Ftinal
Wa F nes
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:
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APPROVED
FOR CONST RUCTION
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