0005-244 (RPL)41; LICENSED CONTRACTOR DECLARATION ,';
I hereby�afflrml6ider 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
61389 653 05l311f
a6 to Signature of Contractor:
OWNER -BUILDER DEC RATION
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). '!
( ) I, as owner of the property, am exclusively contracting with licensed
contractors oto 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:
O 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.
( 11 ) 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 tv`LA1i L I1CjAI 19d . Policy No. 01KROHN91
(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
sub''� dt to the workers' compensation provisions of,. Section 3,700 of the Labor
Xde, I shall forthwith comply with those provisions. }�
Date: ' P,v-Applicant E*rl d Z c'X,e /My•ei
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 of this City to enter upon
the above-mentioned property for inspection purposes.
,Signature (Owner/Agent) )k Date "�` +00
BUILDING PERMIT PERMIT#
`
�. '' f!•'Y �"}.A4,1.{1r�'.).3x y,.w,
VVi7q�"•�°i°D !Y
DATE VALUATION � - LOT" ,, r y,,:TRACT 57 �' a ';•'elf - '
_ .�i�l��: � �li,�r��•�►�J' . "� err• r 'A� � .y A r. _ h
JOB SITE
APN I
ADDRESS^(59s A�.�'�7ZOA iaAlv�1 :
-,
OWNER :
CONTRACTOR/ DESIGNER / EN (NEER.
AAR. 1CI 1vi0AiTIC1N1!PAR
PC)C?I"Z dba .BL.UE I�AVD1 FCC7T. � � SN
53x695 AVLLKMA,:i W
2318 0, VDITEY AVx-ivM BMTER A
LA tai' NTA . CA 92253
VNTAKOz, CSA 91761
(909, )947-CA74, CBW 5.40
4
'
I ISE OF. PERMIT
POOL 1NWOR SPA
a
:
POOL &SPA ONLY -A1 ARMSISARPJeRS 31-LALL BE IN PLACE AT � a
PiRW-PLASTER INOPEi TION. POOL EQUI.PjV. PHT 1rNCLt $URL+ N•4T
t'NCLUDEQ 114 "IS PERMIT,
POOLAND/OR SPA 19t)p,Ofl 1's
I±,S`YMA XD COYr OF C01\('U'C°r'd'ON
x: W.+IIdI
I~'FR;ff. FEE SCIMNIARY
PLAN CHECK FEE 101.000-439.318 199.45
CONSTRUCTION FEE 909-060-41€3-000 $151.00
MECILANIC°AL FEE — POOL 101X060-421-000 $24.00
ZLUC; RIC: M, YEE, — P001. .101-000-420-000 dc3.00
PLUMBING M, POOL, 109 000.4119.000 S'di.00
'ra
SUB -WEAL CON '3`.fR,UCTIL?:1 AM PL61T CHECK
$340.45
LESSI)R:l -PAM P
O.CIf)
TOTAL FEM-T FETES DUE I NOW
rl,
RECEIPT
DATE
1BY
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
POOLS - SPAS
steel
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
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 ow I
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
Final
Utility Notice (Perm)
COMMENTS:
IR
_
HKM
P40S
'BLU-E..-H,_AV 1 .CSO L
� _ k1C.� 4�--:% ...t s � _ J���r� 5 � ,h>_t ...: 1 4`-.:�.. l4•'tl' � _ - l—�� '� (�" � _ ' �, �... { .;� t ' . .
BUYERiOWNER/S -� - ADDRESS-
_ CITY - _ RES. PHONE CONTRACT DATE
MAP BOOK PACE
LEGAL DESCRIPTION •LOT -------- ---�- __
' • - t TRACT , JOB PHONE•
.. ..nl .,ild l.••nlr,r, n., m:k nnwlndpo ' - ,, ,� . ,
.. Ihr Irl., .I rr ;l• Ihh, for the ' _ - • - • • _
�wi�/�� \ �.... • � t `,,.( �.1 ._." � 1!� tri. .�,.'!.1 Z �tr� Y, i. r� _ s, •
1 a• a lil.r 11 111 _ __- 'r/v a.f.1. .r..• •. ,..r _ - ....,:�.,.aY_. .....•.a.. ..r[..,.....� �: ..
r
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. /�� I.L. ��C,.��Y � � • _ , •. . `
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rl�n,; 1. _..... - • -1 .h(f ,y•
.+ and I sMAN.._
11A11S 1' INDICATE LOCATION ON THIS
•.SCAIE DIIAWING OF ALL ITEMS ?
<• .LIS7'D BELOW AND THE FOLLOWING
a. fAUd'I ; BE ACKNOWLEDGED BT '� • _ ��.
•'00, '
InONf.1:R•S INITIALS.'
_v * -/r�`•• - ..-n+'� t
w.r She1•o of'Puol . .r.� ... _......_0
Lenulh_of Pool •�' _ 1 r �`•, .F.
,a-, r- Depth of Pool -- e'. !.. `•bit' A�s •r - - ..J -
Filler Location
rA W 4 Bowd Location vilE I
Light Location
M Led -ler Location
_. Divi rip Board I..ocallon r+(� . t e . !•
Slid,, Location
J HeularQoration �,,. • . - � a 1 QUINTA fi - � ° � •
Dec. In_ location L � O� 1 M - • µ
. CITY 111L1 �Y// ��,
CI,I.� � � � r
iSki. .lar i tfaA,a: ,n_ BUILDING' SAFETY DEPT.,'xR
1 Jt: UI I nn � - • O �..•.ar,W .,r .�`+'�'^+^wd�1Y �• n - 1
- - w ED°
Y MaR111111,n tD - H ** • • C . . - «� Y L ! �"•r•-. �- { ..
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d�CON CT S •'..�
O fUep l' -Mow tinull1- -- - — Tr • - 1 , .Xl +.i•.^ "� �d '-- !MBy• I
M1 nim, n,
i i - ' - DATE • `�---- - . f
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lTl 1 LO ad PGI tt •.._ _. '..•__ ' e a .� � r„�"'1�' �� �,..+�f� �
.•I t ol:. THI:...F01.1OWING ON l• v l - • " .:' >4 `; .. '� '. •' •..�,'
n nauu.6'[tuwn,ions !.•>t. t I, ._ t _, i .
.. '.E Jeauun. (1 n,rrr1y1n11s ' ' ... ' - .� I - .- +.� - � ., • . ` _. • . •
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,�r...t,Toes of Shl.. .'_ - r - .''(.a .- • " Y ( \ T
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