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0102-213 (RPL)• LICENSED CONTRACTOR DECLARATION ` "' Y. PERMIT.# Cn I hereby affirm under penalty of perjury that I am licensed under pr6vlslons of BUILDIN.G� PERMIT �•GH =' Chapter 9 emmencing with Section 7000) of. Division 3 of the Business and Dn7E1 >.� f1 VALUATION LOT TRACT N co ' r, Professionals Code, and my License is in full force and effect. J v f�'��' 1' C,) License # Lic. Class /�Exp.'Date ifs_ !Ch i ���,'� JOB SITE APN f 1 rl-W .y `-- f ./r ADDRESS �}� t t, t �i r �. ; , /� (ter' OWNER CONTRACTOR / DESIGNER / EN INEER o ZCD OSignature of Contracto r=, ~ OWNER -BUILDER DECLARATION °� , } � U ;° MAO;,'�3'OODS s�'�.-1�"�'PoOLS,11,T . W d I hereby affirm under penalty of perjury that I ;am exempt from the Contractor's 4,. � k � 7 190 �SHUND RQ AD 03 � N License Law for the following reason: CA 92253 RMCHO`7AMAGE CA 92270 Z_ ( ) 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 CB.41 , 3735 ?� r sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed , contractors to construct the project (Sec. 7044, Business & Professionals3}T„,00OR 1^ M Code). - LO () I am exempt under Section B&P.C. for this reason W001, & SPS,. ONLY-ALAF M.."A RI�,RS SHALL, BY, TN i�I AC p17 Pitt� N Date Signature of Owner £°,I'ER lNSPI RCT10M.POOL, i~;QUIP�dj�'NT Is."3'��'LOSURI? 2f1 NOT INCI.1,IDEe P' rr� l sar I�7'C Q WORKER'S COMPENSATION DECLARATION e' ° O Z I hereby affirm under penalty of perjury one of the following declarations: LO p O 1 have and will maintain a certificate of consent to self -insure for workers' 'P001,.l+XWOR SPA 26,000 00 L X W compensation, as provided for by Section 3700 of the Labor Code, for the - ,0 J Q performance of the work for which this permit is issued. y Q -U ( ) I have and will maintain workers' compensation insurance, as required by idU Q Section 3700 of the Labor.Code, for the performance of the work for which this d rn H - permit is issued. My workers' compensation insurance carrier & policy no. are: 't Z Carrier Policy No. �. . O l"WEMPTION ON 11MA EMMUTIM COUr 010 C:OVYMIUanQ'.iw ��i dxEl� �2CD Q (This section need not be completed if the permit valuation is for $100.00 or less). PYR&MC YOTV SM k19"RY } J ( ) I certify that in the performance of the work for which this permit is issued, PlAki C:lMK SRM 141.000-'d39-•318 8.10103 I shall not employ any person in any manner so as to become subject to the C;Oi+b4Ti'S�l.1C ''�'!'ON Mr, 101-0100-418-000 6258.30 workers' compensation laws of California, and agree that if I should become KWHANICAL 4TY, -, XXX 101-OOCI.421 ^000 $24,00_V, subject to the workers' compensation provisions opyg'ection-37005'of-the.Labor ,, +. 5 3'd'r ser as - r eq_ r�i<ECTR , AI. FM — POOL 101-000.84.20-000 b � a'. $43.00 ode, I shall forthwith omply with th sp provlsieh-�—•�-= 3 -•r`g to f3iy,�.;� /Applicant ` = ' =' .� • .� ._ T_. - } "L. 9�iF93'4d 31 in -- PL"sol, lfil•000- 4.19.000 � ` y !�1P,a11 J . r• Warning: Failure to secure Workers' Com pensatiorycoverage 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. C � IMPORTANT Application is hereby made to the Director of Building and Safety r' " for a permit subject to the conditions and restrictions set forth on his. application. �� r LA I 1. Each person upon whose behalf this application is made & each person at `•;� q p P SLUR -TOTAL A'I,• CC.}I+1S3:iI�.UC ON AND ;f I.A9 C HWK V1123..ti3, whose request and for whose benefit work is performed under or pursuant to -'� d� • r ": 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. �R13-P��d3 Cfsq�'��' 2. Any permit issued as a result of this application becomes null and void if ,� r, work is not commenced within 180 days from date of issuance of such TOTAL Pmt FE S IY ROW �:r�°` 3 i S permit, or cessation of work for 180 days will subject permit to cancellation. _ .l� I certify that I have read this application and state that the above information is •S. ''' • correct. I agree to comply with all City, and State laws r9lating to the building 1r, construction; and hereby authorize repr..ese_itatives,oVGs City to enter upon the:above mentioned property for in�p�ctio p. purposes -r••—• r� yrs "�� " rw RECEIPT DATE) (`�1 _f� iaYjY \\ DATE FINALED I INSPECTOR • + r r •t , Sig tura (Owner/Agent) �r,A Data;• ' t '� t ' y INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS at Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air YSteel 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 POOLS - SPAS BLOCKWALL APPROVALS Set Backs Footings Steel Electric Bond Main Drain Of _ Bond Beam Approval to Cover Equipment Location Underground Electric Final PLUMBING APPROVALS Underground Plbg, Test Gas Piping Gas Test O Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Pool Cover Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 6-[L Final I Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole I Underground Conduit Rough Wiring t Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) POOL S9E1 m. X—&)—D" X g_5 X.;L Surface Ates � G: rJ Perimeoer� EXCAVATION mess L R s r ),a Grading 1= Dig from 5 kll� LL (a Waft Removed u 4-s Replaced `" t Am { 1 PLUM8016 filter Cel aT size 3 n pump S^ c�t-t Stm l `I l- Booster Pump ^'t ITY OF LA QUINTA �, skim Run MamOr& PA F>� t m: 4 v?o Purifier . a v7� BUILDING $ SAFETY DEPT. wtoaear,er Por✓�la:i5 3� APPROVE® HtrTyp.l2�-� sig o'er' sa:l/F �n . I FOR CONSTRUCTION FOUNTAgi$—$PRAY HOS—WATER EFFECTS I ,y��� �•m �� ntg�J �e.a, Type Vin' Sim . °A BY:Ph""ltipimigill vawes Booster vb5ffYo ; ljrpi Sfae , - ���' fig I �pL R�-�-en� . 3�y � r✓c�e:•� �!i�c•� _ . , �._ STEEL•,GUNfiE Erg stuhuge � as Rc[�. N <� �• b ,S.7Pt cAartst hU-' ti R88LA_ 12' 1$ 24- t Pc L. " S 6L g t Spa WaN Wldtli_ �f cz Step RFsets r y - v 9 ,.r ;, S.Te Benrlies o n,, .► J S'� K Lova: seats A RE-.INSPECTION. ffE OF 30�Jf4TP�2L1`lV{-Q�lDwil� $ WILL BE CHAR ' � - i - �" • . - �. 4 � •, GED'IF TH 144b , mist.. E APPROVED ' PLANS AND - JOB �•Q �_. ELFCTRMrTotalRunUF ESfts-rem; FiberOptic tia E NOTION i. I �� I,, THE SITE F.OR A SCHEDU:LEO--� OA�o Remote INSPECTION. I _F, ----- .. NO'D(CEPTIONS!` :x - . TiLE'wn1i u4o Cn T: . sm- Color- Avg Nd Concft sq Ft', CeMilever to s x ^ l� l�Qu) l��w.h•t t� Step, pOD.UF SPA Sime Cs ` A� u - Per f g Blower_ i � _ SD�Y s' gyp' 1 - - �. �© °IIJTMW FINISH 3 Al aws §ki calor - � .. Other ,• � 2 a , A.'A ti -�. �•e�' ? �-.• Lg�� �ot 4c. e- .s .5 rc I . + CAL-NEV INC.N OWNER fence pod area atida faU self dosinp:artd_self,aatdit fts Pe'r coQe. _.- ------ ---- - POOLS s b`j ; NOTE_N0:dIR fprtMed'alte OWNER �R�e i YVIII be'retltOVed feiit(rted a r day of .0 s�n?t d v L►J P, �►.�'- �. IptMlii p1d'Yil�l fbSYfi N1 . NOTE:' rats).' tt er hose: _ _.L 4 t3 - NOTE Do rrot on`pod x is etnp�y , � � LD 9Y NOTE:Wet do�artcotiaete stte0 at e>mt twice aays shell is ITY SO ATE 13 Mark V. _T - {� ' - — - 9 j: ' � IVI .7��M� V � 5 i •701.80-Thunder Rd. a:. i% ` fl -d, _. +L : E I have reaiewed _ - _ _- PHONE. — �fp ........ t} i Rancho Mirage; California 92270 t _ artd ptan.�. � 760-770-5853 I - - - --, aSTOMEA SON/13M. W - DRAWN BY—4- . -�1 Ucense#777601 celh•phone: 760-83.1-0860