9906-171 (RPL)LICENSED CONTRA7 ON1
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1,hereby affirm under penalty of perjury.that I am IWO
err proMvis.�ons of
Ch�pter 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 �e
/ 636128 C53 W-11i2of
Pte 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:
( ) 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).
( ) 1, 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.
('y� 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 STM13 FLP14P. Policy No. 0416-199-0006 168 . .
(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 becornyubject to the
workers' Zmpen ation laws of California, and agree that ' —
S should become
subje �4 the workers' compensation provisions of,
.50ctlon 3700 of the Labor
CV71 shall - forthwith comply with those p�qyjst��.
'Ze
ate: Applicant—
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(aws relating to the building
A&'
constructiori�' and hereby authorize repres , a Ives of this City to enter upon
30t
the abo've- mentioned property for insp 7otiiii n purposes.
- Zignature (Owner/AgentL_�/ Z Date_��,
PERMIT#
DING PERMIT 99(K-171
DATE 061-2-2/1"VALUATION LOT 34 TRACT 28719
JOB SITE
79-635 CETRINO
APN
709-4-70-028
ADDRESS
OWNER
CONTRACTOR / DESIGNER ENGINEER
DESERTHOU."WNG LLC
CALIF01INLA POOLS & SPAS
5 PARK P,LAZATfR 400
74.725 JONI DRIVE, #A
IRVINE CA 912614
RALM DUSM<r C A. 92260
(760)340-9000 CBL# 355
USE OF PERMIT
P00f, AN D6R SPA
POOL & SPA. ONLY - ALARMSMAMER.3 WALL SE, [W1,11,ACE Xf
POOL ANWOR SPA 15,300,00 LS
E'STIMATED MIST 0 CC
PERMIT FIFX SUMAMARY
PLAN CHECK FEE 101-000-419-31.8
AY7171ONT"Fy
MOIL
az. a r RiC AL r. na - - Po ot .101-000-42MIX)
PLUIMB INQ FEE - X)Q 101-000-419-000
At
IIIESA PRE -PAID FEES
Sol
T 01A V, P I e, I UNI, I T F E F -S 0 1 Jhe N 0 W
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE I INSPECTOR OPERATION T -DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms & Footings Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
0. K to WraD F.A.U.
L.
'all Insulation Condensate Lines
'all Firewall
Lath
- Int. Lath
Final
I ELECTRICAL APPROVALS
I Temp. Power Pole I I
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
Final
COMMENTS:
mnai I - I
I
Final
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
'inal
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
4�aste Lines
Heater Final
,Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Final
I ELECTRICAL APPROVALS
I Temp. Power Pole I I
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
Final
COMMENTS: