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7-_7.-______.-_- 7,, 7
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing #th 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
6�6128 C53 51/201
Signature of Contractor
Date
OWN ER -113 U I ILDER106CLARATION
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).
( ) 1, 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.
(�j,) I have and will maintain workers' compensation insurance, as required by
Se6tion 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 Policy No.
STATE FIND
(This section ri�ed not be completed if the permit valuation is for'$1 00.0 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 3700,0f the Labor
Code, I shall forthwith comply with those provisions.
Date: / /4 � Applicant C-1—
L14rning/: 'Fati/luref to secure Wor ers' 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.
A .1 '
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 representativespVtAis City to enter upon
the above-mentioned property for I , es.
ignature (Owner/Agent) Date
de
BUILDING PERMIT PERMIT #
DATE VALUATION LOT TRACT
116/141199
JOB SITE
APN
ADDRESS
79-000 CALLE BRISA
OWNER
CONTRACTOR / DESIGNER ENGINEER
T.D. DESERT DEVELOPMENT
CALIFORNIA PC)OLS &SPAS
P,O. BOX 1710
74-725 JONI` ORNE, #A
LA QXTINTA CA 02253
PALM DESFRT CA 92260
(760)340-90M CBL4 35-S
USE OF PERMIT
P001. ANO'�`A, S�A
POOL K- SPA ONLY- ALARAIWAARRIERS NAT BE IN PLACE XT
PRE-PLASTFR WSPECrION
PM, L A14EWOK SPA 14,300-00 LS
ESTIMATED COST OF CONSTRI[JICTION
-14,3410,00
PERMIT FEE SUMMARY
PLAN CHE M,' FTiE 101-000-439-318 $105,30
CONSTWOCTION FEE 101-0004418-000 $162.00
MECHANICAL 'FEE -- POOL 101-000-421-000 $24.00
EILEC'MCAL FEE -- POOL 101-000-420-000 V45.00
PLUNIBING FTZ POOL 101-000-419-000
suB-'roT_AL (tOW11kUCTION AND PLAN CHECK
$363.30
" t LE,,SS P "W -PAID FEES
$0,010
JUN 15 1900 TOTAL PERMIT FEL'S DUE NOW
$363-10
" V a7 r
aib I RA
ECEIPT
BY
DATE FINA,�ED
INSP��
77"
11--K
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS'
MECHANICAL APPROVALS
Set Backs
Llnderg�ound Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
ExhaustFans
OX 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
Underground PIbg. 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:
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