0211-081 (RPL)LICENSED CONTRACTOR DECLARATION
C0 I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cel W Professionals Code, and my License is in full force and effect.
`— License # Lic. Class Exp. Die `
o LO
� 7.79
o ZZ � .Date ' 1 ` Signature of Contractor i xr� „t e�� r
.�
(O ' ( .
()(
J OWNER -BUILDER DECLARATION
LU W 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).
C0() I am exempt under Section B&P.C. for this reason
ON' Date Signature of Owner
0)d Q WORKER'S COMPENSATION DECLARATION
o I hereby affirm under penalty of perjury one of the following declarations:
E: r .0 () I have and will maintain a certificate of consent to self -insure for workers'
j< Li1 compensation, as provided for by Section 3700 of .the Labor Code, for the
J Q performance of the work for which this permit is issued.
M Q (� (��) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
` 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE pt,111D Policy No.
co 5
n CY
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 intany manner so as to become subject to the
workers' compensation laws of California and agree thai if, I should become
subject to the workers' compensation provisions of Sectio n'3 OO dthe Labor
3 Code, I s6l forthwith comply with those'p Visions.
Aute: �+�� � t` Applicant f 1 �
Warning: Failu .e to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fine/S up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. t
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth dn. his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuarit to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
it
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby.authorize representatives hof this City to enter upon
the above-mentioned properly for inspection py'rpbses.
-Signature (Owner/Agent) 0A .' l i Date
BURLDING PERMIT PERMI`� .
211-4081
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS 40 C.'Rf.:S'I`A
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
C'.F1WYMT VV-M* 'POOLS
44 095 CA ^M ],A. CRE
X
LA Q{JlNTA CA .92453
tiAJ:.idl P$PIMeC S CA 92162
C�6Uj"F•rCa2�t�+.i �.i�S:;�a:��i
USE OF PERMIT
POOL .t=/0R ,21PA
tr 001.41SPA..11.i.ARYi?IM,AiRAdERS SHALL B.E 1I i Pi_4 ,CI?,AT P3Z&PL&S7.X1t
EQ01PIMENT ENCLC AVO WOTR I:NCLUTD D,
POOL. AAiVIOR SPA 2%000.00 Ls
ZSTHYT . nrn1 cosr op Lo.A7e.apti.TarjG.Gi'
andrptn !'fr"o
PIAN CHFIC'Y. FEZ 101 -000,439? -318 3J46.2$
%Ui+3:I`t'[iUCTION FEE 101 -Nil -418-000 g2"liaa
'12Q 1A:01C:.A'L F=,. -- POOL 101.000.421.000 $24,00
1LFX:'r TICAL FEE - POOL 101-000-420000 5,(10
;a:3 WARTWO FEE -- Pool, 101.000419.000 S27.01D
-' /A\ s,iApt!' Fid S d. , R�.�CVON A141) 1"T"�`i,�°., IK
6 .^!
D M. PPS -9 -FAM I�
$0.00
A
,
.I'0IM1'1�'I'+MIZ'1+RESD :Now
$4671.3
CITYOF LAQUINTA
FINANCE DEPT.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
4
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
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
PLUMBING APPROVALS
Underground Plbg. Test
Gas Piping
Gas Test
10
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
` Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
'N Temp. Use of Power
Final
Utility Notice (Perm)
1
V;
+19" SPA W;
�kl J.
RAISED BOND BEAM @ +18"
6 QUARTZITE SPILLWAY
VENEER QUARTZITE FACIE
+42"
DII.Ej END SEAT
SHEER DESCENT
SPA SET @ }18"
SHEEiDESCENT
3'
QUARTZITE E S PILI,�,VA'l
POOL170
EXISTING PATIO
LARR YAND ROBYN BEST
44095 CAPINO LA CRESTA
LA QUINTA, CA
DESIGN APPROVED BY ROBYN BEST
DATE
�1.
r
+1'2"
JAY!DF 9-13-02
REVISED 9--30-02
REVISED 1(}14-02
REVISED 11-1-02
CI&E
F87S 1]p q) oo I
EQUIPMENT LC Cl