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LICENSED CONTRACTOR DECLARATION
I.,hereby affirm under penalty of perjury that I am licensed under provisions of
'''Mapter 9 (com fencing tfyth 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
/&1e6-2-56 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.
is t T'12t30Tst?� 1
(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 forth ith comply with,lhose provisto E.
t
Date: Applicants-- rn r.� �2 f_'A-..-
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 hist,
application. d
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
to above-mentioned property for inspection
purposes.
Signature (Owner/Agent)_ Ga Date6
f
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION ,,I,�fllltt �!1 LOT TRACT7823
JOB SITE
ADDRESS 7944'10 r�Stl{a EW 11t,
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
BRIAN & LAURA LEG,
Rt,.E, E t:AWENT POOLS
79-210 ASHLET OL
2318S. %rMI N'tlRll 1i.VENU.#'
LA QUIN`1'A, C:A, 92253
ONTARIO CA 9176 t
USE OF PERMIT
POOL )\,NV $;P A. i.1.N1
t►;
V000 APdD'09, GPA i5.0U0.Gi111;:
E5'11MA." EX) C08`A.' Oki' CVNS-1'ft1r`S:`'�'gON
15,1N1'9Dxo r
FEE SUMMARY
�
PLAN (J1F(X FLEE 101.-000-437-518 �!t►5.?;3
CC.9AfWRV(.171014I�TA 1101-t1W-318-0100 S162.00
NFECTL AMICAL FIX __ P0011 1.011-OW-1121-11MI V'ICA A)
.81 IRICrli..0 UE »- t<+t:.OL 10j.-000-420-000 915.01)
N[ UMIMNO 10EF ['00[. 101-WIJ-419-ID lt1 S27'.00
a
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`'1111'►.3111
PAID LESS PRE -1 AID IT'REsS
$0.00
1
`1'UrAl, #'RAMIT F E1,EN 'tail E NC9W
S1idOJO
JUN 0 2=-
1998 .
.
t,JITY OF a, 110
R,,E CEIPT DA E } q L BYy� .# t 'M^4 DA FINA INSPECTOR
ti 11113 x;�{ i( 1
INSPECTION RECORD
4 OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
I,Roof Deck
Exhaust Fans
6;.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel 1-10
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test i
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
i
Final
Utility Notice (Perm)
COMMENTS:
Light
PARTS LIST.
MOTOR - BEATER
20 AMP 2-71I'IROW BREAKER
1 /2" CONDUIT (ADD -4F12 GROUND WIRE IF P.V.C.)
2- 012 BLACK AND 1- R 12 WHITE WIRE
220 V WATERPROOF T1ME CLOCK
1 /2" WATERPROOF FLEX. CONDUIT WtTfI CONNECTORS
urm u
15 AMP BREAKER
1- # 14 RED AND N 14 WHITE WIRE
G.F.I. AND WATERPROOF "J"BOX (ADD 9-12 GROUND WIRE)
SW1TCf1 AND WA I'ERPROOF "J"BOX
BRASS "J" BOX
0
Time Clock
Heater G.P.I.
Panel
witch
Braes Motor
J,
18" Dee
�1Z 4o►S LINE
i
RE.s► t��tcE
S15Z All-Awr H ED SRGe
-Fbiz SLEC, . Rook up—,
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• e�c�e 1954
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3 STFFSII
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(909) 947-6474
(800) 479-5560
Fax (909) 947-4393
2318 S. Vinevard Ave.. Ste. A
Lk- No. 618892-C-53 Ontario. Calttomta 91761
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EXCAVATION `�AAI?P^c
Amts ® X
Boo Cat ShU=6 CK
Remove Out
Remove S wnots,
Remove Fume
Reowe Fence
Remove C*Xrw • S.
STEL
Exoansae Sod Stec Pa=m—
PLUMBING
F*W Run
F.;,
Ronan Unes
Baaarasn Lro
0 Trac
Gas lirr
T
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FGD
ELECTRICAL
Rte+ By Ftq.4_
GUNITE
Love Seat
swim Out
Edi 2nd SUP YES
Rbo k% X FL
Rbb h X FL
COPING
Type STD
TILE
Type
Soa Darn
Acct rile
OECXING
Tyt» -cC
:aaartston .Town
Focangs
wt&M
Oram
EQUIPMENT
Hear Type CAgZ&=44=
Pump _2`ho
is-.
Smartsox
Yes
&ED
AcuaMagta
Yes
Nt
Smar ugm
C!�!:)
No
SCO w uq^t
<5D
No
Smwwac
Yes
(Sq:
F --w y Vac
Yes
QED
Neater LMOPzU
®
Pr.
Slide
Steer Descent Sao
PLASTER
C-Aor,_
SPA
Size ZpA. In Out
Plimoinq Run
cam wag Lamm
Nuenow Of .fats LF
Blower N.P. Yee No
Rarncw_Modsl•
Soa Side Swfth Yes
SrnanugM Yes co
at Watt L q Yes • . Nil
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• Apprvv. ttgtriomant!ocaoott .. - ____—
• Urtcars-,r,d that aecking srvvm is for &=-anon oaroase: x+y ar4
undersand mat Bey ars'z receive =?-Me feet of aecc.
Prepared Especially For:
['BRIAN MIRK LEET
sit -19-21D As"L PL
Cay LA Quim- A Z,o cl7-
Horne.Phor, � oo - `349 WOlK Pt�pne
Oeslcrw
Lat Blocx Tot=
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