RPL (0108-060)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 Exp. Date
""111-1 656•11 28 C53 MC 0: /1 r
Date's Signature of Contractor /' r ��,��
A
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).
O I am exempt underrSection 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.
STATE COMPHININTY
(This section need not be completedif the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work'jor 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
`Date:'& :u E Applicant r
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 authorize representatives of this City to enter upon
the above-mentioned propertyfol inspection purposes.
F1 ` 7 Alf F
Signature (.Owner/Agent) Koe,- .. f Date
UILDING PERMIT PERMIT J/
DATEowl VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
11% I-to's MOUNTMff VIEW
OWNER
CONTRACTOR/DESIGNER/EN &NEER
14.0 AMMDA)VeN 64AS
747:Z5 JM DFX%% 8MM 4A
C1% 92008
PALM DMIKEPT CA 92260
('760>340,0000 CBWI 355
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TOT AL A: ENVU FEES D.11E NOW
RECEIPT
DATEj.)j�/� l
BY /
DATE 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
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
/ 6
PLUMBING APPROVALS
Gas Test
_
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Fi 'sh Plaster
Sewer Lateral
—y - rover
Sewer Connection
Encapsulate, ,
_ _ _
� -
Gas Piping
Gas Test
Appliances
Final
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)
La/TQ c
I�ow.eim�4
S
OF.
I
November 5," 2001
California Pools & Spas
74-725 Joni Drive, #A
Palm Desert, CA., 92260
RE: Pool Permits finaled 11/2/01. without Pre-plaster/Alarm-Barrier inspection.
Permit # Address
0108-060 57-025 Mountain View
0108-062 57-045 Mountain View
0108-058 57-065 Mountain View
0108-303 81-135 Golf View Drive
0107-136 80-080 Riviera
0011-154. 55-495 Royal Saint George'
Dear California Pools,
The purpose of this letter is to inform you that the above noted permits were, finaled on the 2"d
of November 2001 by JAS-Contract Building Inspector Gary Hartman as scheduled by your
company. Office records do not reflect the required Pre-Plaster/Alarm-Barrier inspection
observation prior to plastering and filling the pool and/or spas with water. This letter is a follow-
up to-the courtesy call placed this morning to your company. Please. fax copies of the field job
cards for the noted permits above to the Building Department to verify field records against those
in-house for required inspection signature verification. Should any record submitted confirm the
omission of the Pre-Plaster/Alarm-Barrier inspection, that permit final shall be-,revoked until
such field verification can be completed.
Please contact Daniel'P. Crawford Jr., Building Inspector II, at (760) 777-7027 to obtain any
information you need regarding required inspections. Please contact us at your earliest
convenience within 10 working days to resolve this issue, Thank,you.
Since ly,
ie r r.
Building Insp cto II
cc: file
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