0009-034 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
C lapter 4commencing 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
672850 C53' we
Dat jt Signature of Contractor _>_7,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(,) 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 FREMONT EMPIA)YE Policy No. '6YCN30602 2
I
(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.s�hall forthwith comply with those provisio's1
Date.--
ate. Applicant —.tr
ter:
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
1.
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)-`'Z,T-.-..( A Date �v
BUILDING PERMIT PERMIT#
DATE VALUATION LOT WW -01$4 TRACT
09"%J(K $1110 i =
JOB SITE
APN
ADDRESS 78-595 N"UrS DRM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
R,MIR MORSE
GfiaTUSO FOOL PLi32vD3ugo, Ibis?
78-59S WAYLES DRIVE
667 :EUOMgE RD.
LA. QUSi.3'iA CA 92253
PALM 9Pi3)NM CA 92261
(760)327.7592 CBI.4 816
USE OF PERMIT
POOR., fiND/OR SPA
POf31A3WA ONLY - AI ARMStBARPLIERS MUST 09 IN ,PLACE AT
PRF -PLASTER INSPECTION
POOL A1dDIOR SPA 11.000, 00 L
EssT tx�' M MST OF COMERUCMION
11,000.00
RWf M taUM ArZ'
PLAN CHECK FEE 101-000-439-338 SR1.4U
M- ECHANICA,& "r: EE •• POOL 101-000-4-21-000 S1t1.0R
ELECTRICAL ME - POOL 101.000-420-000 S4 UD
PLUMIITNO tFFE •- POOL 101-000.419-000 $27.00
C10NS'flAUCT10V FXF� 101-000-418.000 $126.00
4A
♦ �r
7 l
Ire MM,'Fa AL. COMMM°C,CON AND PLAN C,TI -CK
$:303.90
IMS PRE -PAID FM
$0.00
C�� . �b
TOTAL PERMUTES :DUE NOW
Sz�4T3.�
3
. I t
RECEIPT
DATE -i f r `"
BY 1 t
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Szt 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 8 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
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
Pool Cover
Encapsulation
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)
9-10-/07/2000 06:26
l, v
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w
7607784920
GATTUSO POOL CORP
PAGE 02
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667 EUGENE RD
SPRINGS, CA 9 r Y
OFC NO) 327-7582 FAQ 20
31CiiSE# 6n&%Y