0007-220 (RPL)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I_ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W Profes`#ona� o16�de, and my License is in full force and effect.
:D ch License # Lic. Class Exp. Date
I- C)^)
IZ
I Z r�_ Date '� Signature of Contractor-rz,--�""�
(gyp O
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Cp OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ 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 &o Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
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WORKER'S COMPENSATION DECLARATION
C) < Cc I hereby affirm under penalty of perjury one of the following declarations:
U.)
FZ O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X w compensation, as provided for by Section 3700 of the Labor Code, for the
Oro J Q p�ertormance of the work for which this permit is issued.
Q C) ( ),fl'have and will maintain workers' compensation insurance, as required by
O CJ Q Section 3700 of the Labor Code, for the performance of the work for which this
13� rn F— permit is issued. My workers' compensation insurance carrier & policy no. are:
? Carrier 'ITATF Policy No.
ob 5 IGh14S'l-00
b
0
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
3 subject to the workers' compensation•provisions of Section 3700 of the Labor
Code, I ,�,afl forthwiih comply with those provisions.. �^
Date: , ' >; VO/ Applicant • — �` e+�' %
Warning: Failure to secure Workers' Compen�#tion 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.
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 of this City to enter upon
the above-mentioned property.for inspection -purposes. j
Signature (Owner/Agent), - _/!' _ r Date
BUILDING PERMIT PERMIT# 1
DATE 'J'VALUATION' LOT 00U7-220 TRACT
JOB SITE
ADDRESS 44-210 CAMM0!o,-!-.. L_c,_ V'Q. f1dQ_1
APN
OWNER'
CONTRACTOR/DESIGNER/EN (NEER
M!M ,GRATLW
DAT9 PALM YVI1vRlPRURS
44.210 CAMMO !A V.WA
81965101OUIT ATN V'11:, W LANE
.1A QU.MA CA 922S3
1Aq11 rrA CA 92253
(760)391-5300 MR. 1.888
USE OF PERMIT
POOL AATWOR SPA
POOL & SPA ONLY -AL ARMS/B.ARCi ERS SHALL BE IW PLACE ATPat
P1..WER INSPECTIO'N.POOL EQUIPMENT ENCLOSURE IS NOT INCLUDRD
114 THIS PF.Rmrr
POOLAND/CSR SPA 110
XS31i"A7W) COST OF C0N9MU(_M0V'
pKmFEE 8VSK4R
PLA14 CHECK YZE 101-000-439.318 $37,7$
CONSTRUCTIOW FEIN 101-000.418-000 $135.00
MECHANICAL FEE •- POOL 101,000-12.1.000 $24.00
Lr'LECTRIC.F1LFE .• POOL 101-000.420-000 $45.00
PLUMBING FELE -- Pool, 101,000-419.000 S27.Q0
1 '
SUB-TVRAT, C01+i;��iYIa DW AND PIAN' CT-WX
$318.75
LESS PPW-PAID T-=3
$0.00
TOTAL P Ai!�;1�.I'�x YAR INOW
X18,75
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
f_�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Setbacks
Underground Ducts
Form & 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
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover 1�t
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 ��C GO+bgL
Gas Piping
Gas Test
Appliances
_
Final
2�
V.4
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduft
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)
.... _ .pry. --- - -.-_' - - --
/eo i
V
/ -7 -•:• � /
QV�N� A
c . O\i
POOL SIZE 7' 3DEPTH i• TO !r- TO_L!
TEMP.NO. FILTER NO.
SHAPE NO. RETURN LINES
ACCESS FT.FENCE T
MOTOR /1y9./ PUMP_ HP /
LIGHT 7 5 HEATER
ELECTRICAL g TILE
GAS`FT. TILE DECKING
XfL7-".1c / i Tr0
PERM. POCL// 6 PER SPA 2-8
SQ.FT. POOL / %n SQ.FT. SPA !�?
POOUSPA NOTES
l•' (Z -5 2,FmorT—
DA'C'E PAL1V[�"ENTERPRISES LOT
Ri'ACIi1R Q LOPMENT, INC.
CEN}ERAL USPA!'LANI)SCAPE TRACT
Irl (760) 398- 166:- Fax: (760) 398-2378
`c-4WN•TJRAC + O-. 13-1; 653; C-27 690775 SALESMAN
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