RPL (0108-058)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 ✓ s'j Exp. Date p
IDate ` Signature of Contractor:"W
'�
v' t,Y a •3'•' •:
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).
() 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.
4{41)"°'1'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:
Cartier 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 if I should become
subject to the workers' compensation.provisions of Sectionp 3700 of the Labor
Code,,:l,sJ�all forthwith comply with thos provisions. of"
,Date: P''l Applicant
Warning: Failure to secure Workers' CompensatiorKoverage,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
W.,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 purpose rrt `
6gnature (Owner/Agent) .`_r �� Date �'°
BUILDING PERMIT PERMIT#
DATE VALUATION LOT f�.�- TRACT
�izbi „CFL%.66(D #�
JOB SITE
APN
ADDRESS tits icy
OWNER.
CONTRACTOR/DESIGNER/EN 'NEER
CARLs. MAD C.A. 9.2008
P.A.i..f!eJ.)C'►,�,al'' T CA 92260
k760)340-9000 �" t 355
USE OF PERMIT
JYMUS.PAALA:f TVt`fr3.�4 ..ZiM SHALL fid; IN PLAC &E M PR.X-PL STFR
POOL A3+ WOk PPA W
Nt F
L' o"NILMIR13iG'il ION NNIS 101 a00-4 I 8116 $743.00
Ff.,l. TRJ,t,RA.L FRE -POOL 101-000-420•000 $45.00
_
PR.IMR1140 FEE POOL 101,-000-419Q00Q A S'aw
AUG -6 2001
-SSUA.-T °IA-1,rCON ...... A>.vD6'Yi� ( 1
- 96.33
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I MAL IT RM I FUESDURNWIN
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RECEIPT
DATE, -%"1
BY/ ( 1
DATE FINALED
INSPECTOR
y.Y -
':02xyK�+'4�t 7�_
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
Final
Underground Plbg. Test
Gas Piping
f5
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
Sewer Connection
P. _„ -I
Encapsulation
�l/�/0
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)
O
OF T t r
November 5, 2001
California Pools & Spas
74-725 Joni Drive, #A
Palm Desert; CA., 92260
RE. Pool Permits fin aled .11/2/01.without Pre-plaster/Alarm-Barrier inspection.
Permit#. Address r
0108-060- 57-025, Mountain View
0108-062 _ 57-045 Mountain View 'r
0108=058 57-065 Mountain View ' y
` 0108-303. 81-135 Golf View Drive ;
0107-136 `,80-080 Riviera
0011-154 55-495 Royal.Saint George . r
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 • a
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 re' against those
in-house for required inspection signature verification. Should any record submitted confirm the'.'
omission of the Pre-Plaster/Alarm-Barrier inspection, that permiffmal"shall be revoked until
a , such field verification can be completed. r`
Please contact Daniel P. Crawford Jr., Building Inspector U, at (760) 77777027 to obtain any
information you need regarding required inspections.. Pleasecontact us at your earliest
convenience within 10 working days to resolve this issue, Thank you.
Since ly,
ie r r.. ,
}
Building Insp cto II y .
cc: file 1 -
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