9908-041 (RPL)LICENSED CONTRACTOR DECLARATION
y affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
0 =) M License # Lic. Class Exp.Dey0olr3
'—QLL, t?5t� 12$ C 5:11120i
oZ r— ate f Signature of Contractor
Or,
rr-ro U co OWNER -BUILDER DECLARATION
HLLIa r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
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
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).
cY) () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
ON
d z WORKER'S COMPENSATION DECLARATION
o cc I hereby affirm under penalty of perjury one of the following declarations:
U') Fa— O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w Y= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q U (K) I have and will maintain workers' compensation insurance, as required by
O () Q Section 3700 of the Labor Code, for the performance of the work for which this
Il H 0) 1-- is issued. My workers' compensation insurance carrier & policy no. are:
t Z Carrier Policy No.
ob d :"x%TiitLl;'�.a �)ev•"`�••!,vS3c�at`ki
J
(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 becor�r a subject to the
workers' compensation laws of California, and agree thV I should become
3 subject to the workers' compensation'provisions�of $eciion 3700 of the Labor
de, I S all fortrhwith comply with those provi 'o
Sr
ke: �6 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
�1 any permit issued as a result of this applicaton agrees to, & shall, indemnify
�^Vip & 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 Stat�grws relating to the building
construction, and hereby authorize representatives of this City to enter upon
thhe<above-mentioned property for inspections purposes. c�
,Signature (Owner/Agent) -•'�"'' Date
BUILDING PERMIT PERMIT{
DATE animi"VALUATION %10,9W.f,4 LOT TRACT
JOB SITEADDRESS 7U-980 (. LF, BRLSA APN
.n.t -
OWNER CONTRACTOR / DESIGNER / ENGINEER
'IT` DE.S.?R11' DE .'EI..OI'RtE 'T (.'r11.1P(?RNIA POOLS ,t SPAS
PO SOX 1716 71-7.S JON( DRIVF. #A
LAOW 1'A i'A 92:`53 PALM DrSERT CA 9:+260
USE OF PERMIT
F't:x.ri., :,!'r�. L�'Af[R. [ i;r+�TU�eF a:, alfsi,� t:�tv4. i' - t1s.A�ht:i�tSrUtittis�c8 :�llflt. L
kii: IN PLACE AT 1' h-PLA.SiItt 1Af,9=tl"Y?rJN.
POOL AMWOR SPA 220,940 P)fi LS
v r r� a a •w rcw��y'1�sur e•ar s�sa�u�v rirr>w rrY.r ruu ►a .r ren rn
sw.1�11 It61`►N G'J 7,1 i..1..I�73 V4d �. 4J1 K.P a. m+tlt. R�aJlti 4af.AtFt=.V1D
PLAN f1tFLX F'IsE 101 -000 -4:W -J19 $140,410
rl3ns�;t`f{Yrc fOtvrTF I61 f0,1.4ts0)(1 6'.prrx�
;tlzir.Itt.r'JK'=U IT4., -• K10L 101-000-421 521 119t
L•1.kA,-I RICAl. 6.fifs —.if c 9.X 161 _00-- V50)
PLtfl+WINOP4.10L It?1-000-419-WO 3�t.iiE1
N1 Wry-f11-Al, ANn MAN VI4 C'K ' 4%1 en
l.ESS 1111F PAID MEN $0 On
101 A.1, PFIRNAIT 111TV-S Of IC, NOW S452.460
f
RECEIPT•- , DATE ,r' BY DATE F/N D INSPECTOR
t�
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 Hacks
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
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:
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert,, CA 92211
Office (760) k 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE ❑ ASPHALT
O REINFORCED MASONRY ❑ FIRE PROOFING
❑
O OTHER
JOB LOCAT ` Q ^. Ije p n `S^
` C7✓� al
ILA0-u `vv -r (�
REPORT SEQUENCE NO.
O(���b
TVP OF_5�1UL7URE
to
PERMIT NO.
D� I I
DAY OF WEEK
MATERIAL SCRIPTION
ARCHITECT
I RHRS.
CHARGED
.�
ENGINEER
ASSISTANTS
HRS. CHARGED
SUB
INSPECTION CONTRAGENECTOR P'7 f.�(<5 C�3YlS 1 CONTRACTOR j .7 �.(.� un, W (y--
DATE
cO N Nt�T oN
w-it`s TD
O
�t'k T
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SI NATURE OF REGISTERED NOPECTCIR _
DATE OF REPORT REGISTER NUMBER