0305-126 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my License is in full force and effect. ,
O =) M License # Lic. Class -^> Exp. Date
r— O L
�'fS3S�i
Z r Date �' af%'�� Signature of Contraction I t•
O
�•�' OWNER -BUILDER DECLARATION
W WW I hereby affirm under penalty of perjury that I am xbmpt from the Contractor's
CL
CL License Law for the following reason:
Z_ ( ) 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).
M () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
p Z I hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain a certificate of consent to self -insure. for workers'
X UAL compensation, as provided for by Section 3700 of the Labor Code, for. the
O � Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
d 0 Z permit is issued. My workers' compensation insurance carrier policy no. -are:
Carrier, j, Policy No.
ao
Q
Q (This section need not be completed if the permit valuation is for $100.00 or less).
J 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/l, should become
subject to the workers' compensation provisions of Section&70dof the Labor
Code, I shall forthwith comply 'with those pfrovisions.�y
Date: y , :< ,_ r Applicant, 1,4' ; f I ./ k
Warning: Failure to secure 1Norkers'Compensation.,coverage is unlawful and
shall subject an employer to crimina�penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
,Signature (Owner/Ag ne t)-- -44 Ar7 I Date t��'•�• �,
J UILD114 PERMIT PERMIT"
DATE_; VALUATION - LOT 0305-126 TRACT
JOB SITE
ADDRESST �V�.CinldCi �e,F�}: •.
APN
OWNER
CONTRACTOR/DESIGNER/EN &NEER
MCCAI. 141 0M Pool's
44.600 MONIFICE9,10 Aw 67E
82.762 C MRLFZWW:l•1' AzVIL
L.A. QUII`3 TA CA 92233
1ND10 CA 92101
Q60)27:5.6403 CIBLO
USE OF PERMIT
PO (TaNDjO1 EMA
PCIOUSPA. A.�..WkRMWI3ARkZ1 RS Sf' ALJX_ HE IN PLACE AT PRE—PLAS'i'I::R. ..
INSPW- ION. WUM IT .MUCISURK NOT INCLUDED
POOL A NWOR SPA 14600.00 lab
PLAN CHECK FOR € 01.000.4?i9-318
CONSTR.UCTtOX FEE 109-aJQ0-41$-0150 �SI92i.00
MECHANICAL FEE -- POOL 101-000.421.000 01100
Lr'I.SfCTRIC'..AL FRE, - POOI: .. 101-Cft-420000 $445.00
PUU!• BINOFEE-- POOL .101-00.0.419.000
. Vim..
SIM -TOTAL CONMUOMON'. i ia' C 37M
34.22.70
LOW PRE-VATO RM
$0,00
.FORAM FIRAS D1,I : NOW
9.4.22.'10 .
MAY 2 01®03
CITY0�
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cru OUl�trn r
RECEIPT
:BATE EPT BY
h E 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
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
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 OF LA QUINTA SYB-CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER + OWNER BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous 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 commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of buildina c)ermit. For each annlirahla trariP all infnrmatinn ranionetnri hnl^— --+ I— .+--nin+e,a a., ---I:..--
Trade / Classification
Contractor
State Contractor's License
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number.
(xxxxxx)
Exp: Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
CONCRETE (C-8)
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FRAMING (C-5)
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STRUCT. STEEL (6-51)
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MASONRY (C-29)
PLUMBING (C-36)'
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LATH, PLASTER (C-35)
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S-3
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DRYWALL !C-9)
HVAC (C-20)
ELECTRICAL (C-10)
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"ISO,
"ROOFING (C-39)
.i
°SHEET METAL (C-43)
FLOORING (C-15)
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISK (C-42)
PAINTING (C-33)
f
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
S
ic
montecello drive
GENERAL SPECIRCATIONS
SHAPE CUSTOM "-
JETS 4
RAISED
BENCHES -
BOOSTER
' APPROVED BY:
(7 6 O) 2 7 6 -6 4 O 3 THIS DRAWING REMAINS THE PROPERTY OF MCCALLUM
POOLS. REPRODUCTION OR UNAUTHORIZED USE
INDIO, Citi WITHOUT PERMISSION IS PROHIBITED.
w�
ic
montecello drive
GENERAL SPECIRCATIONS
SHAPE CUSTOM "-
JETS 4
RAISED
BENCHES -
BOOSTER
' APPROVED BY:
(7 6 O) 2 7 6 -6 4 O 3 THIS DRAWING REMAINS THE PROPERTY OF MCCALLUM
POOLS. REPRODUCTION OR UNAUTHORIZED USE
INDIO, Citi WITHOUT PERMISSION IS PROHIBITED.