0007-017 (RPL)I1 p ALICENSED 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
483498 D C53 12/11 iv
DateCG Signature of Contractor t-'�`z• ��` ^� "'+
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
slahereby. 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 10310N INSURANCE Policy No. 'WC34191093
(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 Section 3700 of the Labor
Code, I shall forthwith comply with -those provisions.
Date: '7f/i fn rr Applicant t'n r te- o _ G f. f• ,/ c� .-%
., /
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 property for inspection purposes.
Signature (Owner/Agent)/" ,r ` . k1nere-'1 Date f!% z-1 r1
r -
BUILDING PERMIT PERMIT
07-07
DAT. 1 VALUATION LOTTRACT
JOB SITE _
ADDR SS %-� �'
rN _ L
OWNER
CONTRACTOR / DESIGNER / EN INEER
1?t,UCp1 2 gLi ,i ERCIi;IFL & ASSOC.
P, U1R.F1",1~7 POOLS A14D CONSTRUE ON
78615 NALPL :S DRIVE
1',O, BOX 1524
Iyk QUEaTA CA 92253
PAU1 DESEERT CA 92261
(760)568.4963 ('MIA 725
USE OF PERMIT .
POOL ANDIOR SPA.
POOL & SRA 014LY-A1AARMSIBARRIER. SHALL HE IN PI -ACK AT P
FLASTE.R I• ISPECTION.P001, EQUIPhigHT DICLOSURE 12 NOT DICLUD-W
IN THIS PERMIT
POOL ANDIOMPMA 11.400.00 LS
30MMEED COST OF C0.1`TTIRUCROK
11,4W.00
P7N ;iYi T FIM SUMMARY
PLAN CHECK ITEE 101.000-439-318 $67.75
CONSTRUCTION FEE 101-000-4.18-000 $135,00
MECHANICAL FEE •- POOL 101.000.421.000 $24,00
ZLF.X:TRICAL FEE - P0€11, 101-000-420-000 $45.00
P'L` MB.1NO FEE -- POOL 101.000.419.000 $27.00
WJ13-3'0 rAL 00140'i`P.U'C:`1't09 AND PL" MT CK
$316.75
IMS PR&PAID.IMS
$0.00
'MM I''N-Iffl ff'E'ns DUE NOW
$318,75
RECEIPT
DATE
BY \)/
r . �y
DATE FINALED
INSPECTOR
A,
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
OX 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
Bond Beam
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
ff
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:
FROM : PURRFECT POOLS&C"TRUCTION FAX NO. : %03609829 May. 12 2000 11:36AM Pd
4W J, a.11 JLAJj
r44.1
A REINSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
v
CITY OF LA QUINTA
4t
BUILDING & SAFETY DEPT. 00
APPROVED (Q
FOR CONSTRUCTION
ung aq.�q 1 t790=60 00-TT-LnO
ZO"d
REQ -
WESTERN INSULATION, INC.
4211 Latham Street, Riverside, California 92501
Tel. (909) 686-8760 Fax (909) 686-8786
INSULATION CERTIFICATE
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:
TRACT / PHASE: BELLA VISTA TRACT # 28458-3
LOT# 17
SITE ADDRESS: 78545 NAPLES DRIVE.
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EXTERIOR WALLS:
MANUFACTURER: Johns -Manville THICKNESS: 3 5/8" R -VALUE: R-13
CEILINGS: BATTS BLOW
MANUFACTURER: Johns -Manville THICKNESS: 13"VALUE: R-38
CEILINGS: BATTS BLOW
MANUFACTURER: Greenstone THICKNESS: 10.3"VALUE: R-38
GENERAL CONTRACTOR: TRADITIONAL BUILDING
LICENSE NUMBER:
BY:
TITLE:
DATE:
INSULATION CONTRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER: 481278
BY:
TITLE: PRODUCT(ON MANAGER
DATE JUNE 23,2000
I