0308-116 (RPL)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
3121'372 C53 C8 08/33A�C
,Date "!ff !` Signature of Contractor. 'j'' •' r! : r� '
i.a
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
conteactors to construct the project (Sec. 7044, Business & Professionals
Codej.
O I am exempt under SectionB&P.CAor this reason
Daie
s'`�..a:.-� Signature of Ow.,ger._, ��'=
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 -have and will maintain a certificate of consent to self -insure for workers'
oo'mpensatiori, as provided for by Section 3700 of the Labor Code, for the
performance`of the work for which this permit is issued.
O I have and will maintain workers' compensation insurance, as required by
.Sectlon'`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:
Camer,.-8T1ar g Fum) Policy No. 22,04006377402
(Thissection-need not be completed if the permit valuation is for $100.00 or less).
( ;) ;L'certify that in the performance of the work for which this permit is issued,
I slialllnot.erriploy any person in any manner so as to become subject to the
workers''compen sation 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
! J',// : • e r
' Signature (Owner/Agent) Date
� �'"' •' �� "
PERMIT#- .
BUILDING
PERMIT
DATE VALUATION LOT TRACT
JOB SITE
]APN
ADDRESS 51-120 AVEffffl. )A��.,i WPXZ
OWNER
CONTRACTOR /DEESIGNER/EN INEER
'
MR. &:Yake. dODPIyytVEZ
C
11M0P_CS/w, P.00
51-12,0eA. JMA.RA -M,
81-565 3,'4:iAi)0W,A ril
LA QUT�7`�',.A CA 92213
Ilv 10 CA 92202
.(760)347-3218 061A`Y' 5238
USE OF PERMIT
POOL/01Z SPA
POOi.. ALAF:idi118ARPLIERS SHALL BE IN PLACE AT PR&Pf.._A_SY1a: 1
INSPWFION, 9QUIPMENT ENCL0$UPM NOT WCLU.AE6
P001, .t NWOR. SPA 19,000,00 L3
Ems' INIVrm) COST OF COMMUMON
71$3pmwo
PLAN C13ItiCK ME i01Q000�3u-�tt� $I�."�
C.'ONSTRIJCTIOPI FEE 111'1-000-�18.00Ct !�I99.�if_r
FUCTRICAL M. -• POOL 101.000-420-000 $45.00
P1.UMBINO PER - POOL 101-000.419-000 $27.0b
D
D
.FUG .1120 o3
CITY OF LA OUPT A
FINANCE OE
liP.l'C�iON AIM PLAN` C.''HWX
$398.70
U00 PRE -PAD R- P
$0,00
"CO YAL PERNIM P + EN DUE NOW
SM.70
v
RECEIPT
DA_5 ;
BY ��
Dqi INAL /�U.
INSPECT
INSPECTION, RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs !
Underground Ducts
Forms & Footings 1
Ducts
Slab Grade I
Retum,Air
Steel 1
Combustion Air
Roof Deck i
Exhaust Fans
OX to Wrap )
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L. I
Grills
Fireplace T.O. I
Fans & Controls
Party Wall Insulation 1
Condensate Lines
Party Wall Firewall I
Exterior Lath i
Drywall - Int. Lath I
4
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs I
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
1
Underground Electric
Underground Plbg. Test
Final {
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Unes
Heater Final
Water Piping f
Plumbing Final
Plumbing Top Out }
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral l
Pool Cover
' Sewer Connection
Encapsulation
Gas Piping'.' 1
Gas Test - +
Appliances. - }
-
Final
1
Final 1
Utility Notice (Gas) - 1
ELECTRICAL APPROVALS
Temp. Power Pole I
Underground Conduit
Rough Wiring
Low Voltage Wiring )
Fixtures ;
Main Service
Sub Panels 1 Exterior* Receptacles
Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power',
• 1
Final
Utility Notice (Perm)
COMMENTS:
GA 6_1
or,
IILVA-
a
0 14 PE
Ix Puiv-A
t
3
,f it 6CE
POOL &PECIFICATlONS 1_2\
SIZIE43X.- SHAPT - . -C If Tri,
PEAUIIIETER_` EA
EXCAVATION
RAMP &O GJRADIN�_ vuwpszL_
swimour e. -O - -- - FSE
Cow-RiTE
_SED a.&-'..
:STEEL
SMf=_LOVE
SFEAT_s"P`.
i0CHARGE _ POOL LIGHT
RAISED SONG BEAM —SPA
PLUMBING
SUCT_/� RET-43PUmp_tI7P_
SOLAR. POOL SWP.
HT.Jgf-e; F I L T I- A .4- kle, Z- - FILL 1 :NE
.SP,k' —SPALIGHT--- _4tET_Lz._.JFETS_
BONDING
PATIOS. DIV. SO.
SLIDE OTHER AFL
GUNITE'
RAMP NOTCH BA LOVESEAT—
RAISED SONP. a P.S. STUB
SWI MOUTf XIC
ANCH
ul
,TiLE&'CQPI?4G
TiLETRIP `,P' -SPA WALL W 'ITH
RLASTEW�,�y;-
COLOR.4��� SPA_4��
DECNNG
BY--rZ-- Trp FeAaC,_-f�.
FINISH
ELECT By ft2r_
7 3
T
ADDITIONAll
'NOTES:'iz--;
"y
zn- DESIGNED
A CUSTOM POOL
ESPECIALLY-
7777 7 ' 7
w
J., 77 7. _7 r777'
_'MAP PAGE
NAME'
ES
41&=
.77 -t� 1�00L AREA TO at FF_NCE_0.,?Vt_;PU!
rJ -77
OROINANCE CATES TO BE SZL�-_CLDSI,�G A.
kX ST E
flxz "M1.5
u
L V
KlUillr+a WHET iMELL AT, LEAST TWIC
00)�N CONCRETE
. . . . . . . . . .
1 4ywK
TROPIC
SWIMMING POOLS. - INC: "
P.O. BOX 177i-'_'_
INDIO, CA 92202 .
1
TEL. 760-347-3� 8
•
CONCRETE
LICENSED
L
REPAIRk_-, UELING
7'
LARRY MOR, NMI8 0 root 3 &
STA
or,
IILVA-
a
0 14 PE
Ix Puiv-A
t
3
,f it 6CE
POOL &PECIFICATlONS 1_2\
SIZIE43X.- SHAPT - . -C If Tri,
PEAUIIIETER_` EA
EXCAVATION
RAMP &O GJRADIN�_ vuwpszL_
swimour e. -O - -- - FSE
Cow-RiTE
_SED a.&-'..
:STEEL
SMf=_LOVE
SFEAT_s"P`.
i0CHARGE _ POOL LIGHT
RAISED SONG BEAM —SPA
PLUMBING
SUCT_/� RET-43PUmp_tI7P_
SOLAR. POOL SWP.
HT.Jgf-e; F I L T I- A .4- kle, Z- - FILL 1 :NE
.SP,k' —SPALIGHT--- _4tET_Lz._.JFETS_
BONDING
PATIOS. DIV. SO.
SLIDE OTHER AFL
GUNITE'
RAMP NOTCH BA LOVESEAT—
RAISED SONP. a P.S. STUB
SWI MOUTf XIC
ANCH
ul
,TiLE&'CQPI?4G
TiLETRIP `,P' -SPA WALL W 'ITH
RLASTEW�,�y;-
COLOR.4��� SPA_4��
DECNNG
BY--rZ-- Trp FeAaC,_-f�.
FINISH
ELECT By ft2r_
7 3
T
ADDITIONAll
'NOTES:'iz--;
"y
zn- DESIGNED
A CUSTOM POOL
ESPECIALLY-
7777 7 ' 7
w
J., 77 7. _7 r777'
_'MAP PAGE
NAME'
ES
41&=
.77 -t� 1�00L AREA TO at FF_NCE_0.,?Vt_;PU!
rJ -77
OROINANCE CATES TO BE SZL�-_CLDSI,�G A.
kX ST E
flxz "M1.5
u
L V
KlUillr+a WHET iMELL AT, LEAST TWIC
00)�N CONCRETE
. . . . . . . . . .