9906-098 (RPL)U)
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LICENSED CONTRACTOR DECLARATION
1. h;reby 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. �Da �e
IJ56�,28 C,53 IP -01
f Y, Signature of ContractoL,7,,.,,
dte
OWNER -BUILDER DECLARATION
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 worke�r�.
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of t�e,�work for which this permit is issued.
()) I have anAill 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:
Canier Policy No.
I -
S'rjk'fF -tTN
(This section heed n(5t be completed if the permit valuation 1(S4T66_r%91J0Wr0Tess).
( ) 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 sholwlel�tecome
subject to the workers' compensation provisions of Section 3,��f t�e Labor
Co�e, I shall forthwith comply with those provisions.
7
,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 thi's 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
7,
construction, and hereby authorize representatives of this'City to enter upon
Zthe Above-mentioned property for inspection purpose
ature (Owner/Agent) Date
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT "06-098 TRACT
06/14/1" $15."0.00 13
JOB SITE
APN
ADDRESS
I
79-060 QkLLE BRISA
OWNER CONTRACTOR / DESIGNER / ENGINEER
T,D, DESERT DEVELOPMENT CALIFORNIA MOLS & SPAS
P.O. BOX 1716 74-72-5 JONI DRIVE, #A
LA QIANTA. CA 92253 PALNIDESERT CA 92260
(760)340-9W) CBL0 355
USE OF PERMIT
Peel; A-N1_-*4eA SPA.
POOL &SPA ONLY- AL'U"I" ARRIERS HJST BE IN PLACE AT
PR&PLASM INSPECTION
POOL XKDAL)k SPA 15,900,00 LS
ESTINIATED COST Or, CONSTRUC('10N
15,9114).0o
PERMIT FEE SUMMARY
'PLAN CHECK FFF, 101�000419318
CON STRUCTION FEE 101-000-419-000 $171.00
MECRANICAL FEE. -- POOL 101 -00042 I-= $24,00
ELECTRICAL POOL 101-000-420-000 S45.00
PLUMBING FEE — POOL 101-000419-000 $27.00
TOT
LESS PRE -PAID FEES
$0.00
JUN 15.1999 TOTAL PERAirr FEES DUE: NOW
$378.15
1P ,
0 a Y Lj Q!
'RECEIPT
DATE
DAT FINALED
INSPEWR
71
INSPECTION RECORD
OPERATION __7
DATE -T—INSPECTOR
OPERATION
DATE —T—INSPECTOR.
BUILDING APPROVALS
MECHANICAL APPROVALS
Set. Backs
Underground Ducts
Forms.& Footings
Ducts
Slab:Grade
Return Air
Steel
Combustion Air
Roolf 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
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
If
Final
Gas Piping
(ZI
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
/L
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
LOW Voltage Wiring
Z-Fixturm,,
Main Service
SubPariels
Exterior Receptacles
G.P.I. *
Smoke Detectors
Temp. Use of Power
Final
ility Notice (Perm)