0204-111 (RPL)n 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
7 ii Q C5� m�ic '" _ l:i0103
Date V_ 47' •LL i n ture of Contracto�1''''"'-)
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
e 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 IST.I TE FUND Policy No. 161,1074-02
(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"-provisioris of Section 3700 of the Labor
Code, I shall forthwith comply ,with those`pr`ovisions.//
Date''./' / /` ;—° Applicant ... •r if �.. X
Warning: Failure io 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 purpo es.
rlA
Signature (Ownegen) — - Date
BUILDING PERMIT PERMIT# 'J
DATE VALUATION LOT 02014-111 TRACT
JOB SITE
APN
ADDRESS 52-395 AVINID.iA. L.IERNTUDAS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
52-395 AMMUDA M3S.MMAS
667 3r'd7t3ME M.
LA QXTI2TAA. CA 92253
PALM SWRM ; CA 9226'
USE OF PERMIT
POOL ARD6M' SPA
POOL ONLY. .1JAF21U W4A9R19.RS SHALL BE IN PeACfl:MOR TO
RtRP .,AWRlt.:tPt4"M,T'ION. POOL, 900)WINT ENCLOSURE NOT iRCUJOUD
it'll i>r.1'tmil1.r..
POOLi ANDIOR SPA L,Z1F
XS17MkCOS air CO4TaU';;M:N
i".4'.3�i.d4TJ1.141 FXV MINIMA9Y
PLAN 01114Y-19 M,
C074STRUCTI ", -4 s)^�! 1. �OC7fl X517.00
ELS"!'CUC',AL FEE -- POOL 101.000-420-000 �ri'i:£►9
r
PLAU a;BIN0, FIN& POOL 101 -MO -419-000 07.00
F. `1OWS'SYUCHON AND MAXT CM?CK
$265.05
Ureas PIM, TAID FM
$0,00
APR 1001 >'X,� �, Prnom' VER's DUE.Kovit
.
.17
YOF
RECEIPT
DAE .Z
BY
DAgFINF�ED
!l-��
INSPECTOR
.�
EO�
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
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
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
(�Y
Gas Piping
Gas Test
Appliances
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)
Final
COMMENTS:
04/15/2002 08:04 7607784920 GATTUSO POOL CORP
84/15/2082 87:20 750778MO GATTUSO POOL ujw PAGE 02
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 61- / 7 - 0 BY .
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A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
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A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
_ -1