9905-286 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
I.— Chapter 9 (commencing4withs•Section 7000) of Division 3 of the Business and
04 W Professionals Code, ant my LicA'Ise is in full force and effect.
O =) ch License # Lic. Class + Exp. Date
In
R W
ZZr �/ate �; Signature of Contractor
Z0 0 J,V C:) OWNER -BUILDER DEC-rARATION
LU d I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Cl) License Law for the following reason:
Z (. ) . 'l, 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).
M - () I am exempt under Section B&P.C. for this reason
�.
N Date Signature of Owner
0. C\1
CL Q WORKER'S COMPENSATION DECLARATION
j �• � I. hereby affirm under penalty of perjury one of the following declarations:
n O ! () 1 have and will maintain a certificate of consent to self -insure for workers'
K W' u- compensation, as provided for by Section 3700 of the Labor Code, for the
nJ Q performance of the work for which this permit is issued.
Q; U (�) I have and will maintain workers' compensation insurance, as required by
(�
Section 3700 of the Labor Code, for the performance of the work for which this
L H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier Policy No.
^.` 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 become subject to the
workers' compensation laws of California, and agree that if I should become
subject,to the workers' compensation provisions of Section 37 U•of the Labor
Code', I shall forthwith comply with those provisions. a- �
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
Work Is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
U I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives pJANS' City to enter upon
theabove mentioned property for inspection pur oSes.
�J$ign" ature (Owner/Agent) Date f"142 r
:J I
BUILDING PERMIT PERMIT#
DATE VALUATION LOT "05.786 TRACT
JOB SITE/ I
APN
y
ADDRESS 79-480 l.ttLLE HRINA
- »
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1"D. D S1111'r DEVI-11.011,4l NT
C11#-.►FC3It.MA COOLS & SPAS
P.O. BOX .1716
74-725 ONI DRIVE, HA
LA Q(1lWA CA 9225:1
PALM DESERT CA. 92260
f7641j340•-9000 CRI,# 1455
USE OF PERMIT
POOL AKDi0R `a'.PA
POWSP.A, S.- B. -RQ Cil i' - AI.A1tH9/B.,�RRiEkt`.1 IviCiST AF IN PLACE AT
I'4t&PLAS VR 1NSNlat,lKYN
s`rOK'+2, ANDMIR ahA. 1:;),101"01, LS
ESTINW ED COST Me CONSTRUIC, rtaN
15,1100.00
i\%ila't HA:N.1CA1. FEE --P001, 1.111-1}( -421-OW $W1.0
PLU410l'lart°IG VIM _ PO(N. 101-000-40,000 S1217.00
PLAN C;,14EC:`K FRI"" 101-000-439.318 5111.15
GIONST VC -1:100 FRE 101-W1-418-600 5171.00
5134-11011A1, t.('iA)S I'I UCTIII'_1N AND "PI -AN CMTECK
$378.15
LESS PRI,-t',/lID Ft1X,8
$0,00
t
RECEIPT r r�
DATE
I BY ` '" tiL
,PATE FINALED �j
INSPECT
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
Reef Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Farming
Compressor
Ins iation
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
yLGe
k2
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
71- 41
COMMENTS:
_
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
Utllity Notice (Perm)
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
J08 LOCIT()— ()� ^(+�
�
1e .p n ( S�
LA Qu`�,�.(1,
REPORT SEQUENCE NO.
TVP OF_SJJiULTURE
LoT /�
PERMIT N0.
D 1 9
DAV Of WEEK
MATERIALCRIPTION
S
_� 3
ARCHITECT
I R
MRS. CHARGED
ENGINEER ASSISTANTS HRS. CHARGED
DTE
INSPECTION GENECONTRACTOR Pry f KS l.�Yl.�� SUB CONTRACTOR ,.7 il.L=L -,qi
CO N 1-►E�T d� (� �� � � r �
COPY SENT TO CLIEN
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.
IED ON NEXT PAGE O PAGE OF
SIGNATURE OF REGISTERED7CA C)CTO 6� j
DATE OF REPORT --�4-REGISTER NUMBER