0403-175 (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
802919 Casa .11 C 01131/2(
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 STATE 1*C4-ND Policy No. 11*395XO3
(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 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 perso
whose request and for whose benefit work is performed under or pursua
any permit issued as a result of this applicaton agrees to, & shall, indem
& hold harmless the City of La Quinta, its officers, agents and employe
2. Any permit issued as a result of this application becomes null and voi
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days'will subject permit to cancellatio .
I certify that I have read this application and state that the above information
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. t
Signature (Owner/Agent) Date -'
PERMIT#
•
BUILDING PERMIT
0 4M•475�
DATE VALUATION ppaa LOT TRACT
(Yll �ryrvv.+�
JOB SITE
APN '
ADDRESS °3.-"20 s` V NITA RARMVF�Z
OWNER
CONTRACTOR / DESIGNER / EN (NEER I •'
D R E A.DE U-0,
AZURE POO?- SPAS
53a820A TTDARPI&PF?Z
RO,BOX IWI
IAQUINTA. C.A. 9^4253
PALM JRS'0ZT CA 922:55
(760)322-7665 CB110, 3382
USE OF PERMIT
POOL ANTi1,EOR SPA
POOU PA. Af..ARMS/HA}' WERS SHALL BE DI PLACE AT PRF,-PLAS'i'FR ;
INSPECTION, ''gQU]PkiENT .gNCLO0UPS A;OT n4CLUDED
POOL ANUOR SPA. 1S,Of+0,U0 1.S
Pl' B2'Urr film 917IVI&URY
3
!
PLAN CHECK FEE 1.01.000.439.318 -A $103.30
,'
CoOAIVAUCTION PGE 101-000-418-000 Q \. $162.00
MECHANICAL PEE — POOL 101-000-421.000 .95 $24.00
L'LECf RJC.AL PGG - POOL 101-000-420-000 `� `-4 �3.C►0
-
PLUMBING PSI1. - POOL 1014000.419.0014
AL C�ON�c�L'1CM014 AWD PLAN CIMC K
$363,30LESS
PRE-PAIDPl3)3S
- $0.00xOTAi,
YI+ sex FEES DUE NOW
n
m 0
-
RECEIPT
DATE, , / /�
BY `
D 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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
RoSgh Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
r
AZURE
POOLS & SPAS
POOL & SPA SPECS
P0.01- SIZE: IT X 30'
POOL AREA:349 SF
SPA +18"
"OL -PER: 82FT
WITH TILED,SPILLWAY
�POOLDEPT-ft, XTO 6
"SIZE 7"
SPA AREA -'SF
PA "PER' 25 FT
DECK `ARE --A-5 5.
'.' z -SF
COLOR/FINISH:
PUMP
F'J 'I
L -T -ER
MEM
TANNING'.',LEDGE
WITH "UM' ,RREL-LA.SLEEVE_
yS
CONTROL:
C
!E, -,"A
-C NER!--
I
P/L
IL
POOL LIGHT:
SPA -L- T:-'
SO
MR & MRS DEUEL
ADDRESS: •53-820 AVE RAMIREZ
CITY: LA OUINTA
Lo -T #' :