9804-135 (RPL)U)
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LICENSED 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
ti '4ti C53 V311199
Signature of Contractor / 'fe
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
pe ormance 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.
(This sectio need Ino be co p1eted if the permit valuation isfor $11001900 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: 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 laws relating to the building
construction, and hereby authorize representatives of9this City to enter upon
tth 4bove-mentioned property for
,fi.nsetn urpo(es.
Signature (Owner/Agent
Date t/ .
_�
PERMIT#
BUILDING PERMIT
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6QN.TROL#qp
DATE VALUATION LOT 9804-135 TRACT y� 4.i
g� ®VV
r $A�.4T11fl.011
JOW° ITE
APN
ADDRESS
49-015 BALADA CT
OWNER
CONTRACTOR/DESIGNER/ENGINEER
THHOMA.,S N c JAN.A Iw LIOUGLASS
MCINTYRE POOLS R:
SPAS
419035 TBALADA CP
P,O. BOX 1?9I -
LA QUIN'T'A CA 92253
LA QUINTA.
CA 92253
( 60)360-3585
CBL,# t945
USE OF PERMIT
of rr
OR
P00USPA. f-AWY, ALARMWART. E—AS ARE `I O BE OPE-KA.i IC>tNAL MOR
TO EN -CAIS PRL: -PLASTER IPf PECTION
POOL AND10P,SPA ts,twv:VALS
PAID
APR 2 3 1999
r ; li
0FL1 AQUiN...
.CSITNIATC, D COST Cali' COMM Rt3C'1`1ON
15,ollo.00
PEERIVMiT FEE 5UI4+MIARY
PLAN CI:WCK FEE 1.01-000439-318 $105.30
C-014STRt; CTIf).N FEE YQ"!-•000-419-000 5162,00
ita4 1[r>,Tol...CA[ FF 101-000 21-000 $24.t30
ELEC"/WCAL FEW -- POOL 1I7I-000-420-000
PI:.UNMING FEE - POOL 1.01-000-419-000
l
SUB TOTAL CON-$LrRUC:'-f10JN ANIS ALAN CHECK
$363.30
LESS PIPE-.PAW.FEES
$0.00
i'OTm, .P.ERNUT FEE'S IDUE NO'%V
X363.30
RECEIPT
DAT�h
BY
DAJEF ALE
INSPECTOR
0
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
Set Backs
steel
Electric Bond
POOLS - SPAS
Footings
Main Drain
Bond Beam -
Approval to Covet
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
Pool Cover
Sewer Connection
Encapsulation
_
fj
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. lase of Power
t
Final
Utility Notice (Perm)
COMMENTS:
AT I --
CITY OF LA QUANTA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SuW-tQ i TO INSTALLATION AS PE
AND ALL APPLIC/ABLECO;S
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