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.4 LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisievi -4—
Chapter 9 (commencing with Section 7000) of Division3 of the Business and'—
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
� C53 ]0131/98
Date �:6'1'Signature of Contractor
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.
( ) 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.
1need nolt�e
(This section completed if the p
( ) I certify that in the performance of the
I shall not employ any person in any man
workers' compensation laws of California
subject to the workers' compensation pr V
Code, I.shall forthwith comply with those pt
Date: " t ' ° < Applicant
valuation is Tor 00.00 or less).
/or which this permit is issued,
o as to become subject to the
agree that�if -Should become
s of Se_ctr6n 3700 of the Labor
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 applicatic
correct. I agree to comply with all Cit
construction, and hereby authorize
the above-mentioned property fore sr
Signature (Owner/Agent)
nd state that the above information is
id State laws relating to the building
sentatives of this City to enter upon
on purposes:"'
Date
y BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT 9803-1 f6 TRACT 8707
515.'t1111.(i11
JOB SITE
APN
ADDRESS
79-146 VET1tINQ
_
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MARVIN HOMES
CALIFORNIA POOLS 8c SPAS
51-370 AVENIDA BERMUDAS
74-72.5 JONI DfUVE, #A
LA QUINTA CA 92253
PALM DESERT CA 92260
(760)340-9000 _ CBL1r 355
@ a
USE OF PERMIT
PO
i
POOL AND SPA /BBQ VAID
AR 2 6 199R
CITY ®
F LA QUINTA
POOL AND/OR SPRY 15._%0.00 LS
1J8TIMA'1.'�D COXT OF CONSTRUCTION
1:�,51E0.1490
PERMIT 1FE SUMMARY
PLAN C1 [ECK FE 10.1-000.43` -31.8 6111.15
COTd3'f UC"t:ION FIM 101.000-418-000 $171.00
NWHANICAL FEE-- POOL 101-000-421-000 $24.00
EIEC" 1`R1C.AL FEE -- POOL 101-000-420-000 $45.00
PLUNMINCr FEE -- POOL 101-100-4119-000 $27.00
SUB-'rGrA:L CONSTRUCTION AND PLAN CHECK
$378.15
LESS PRE -PAID FEES
80.00
TOTAI, PERMIT )"EES DUE NOW
$378.1.5
RECEIPT
DATE {{ f
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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
_lam
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
A C..,rz
Gas Test
-
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: