9707-029 (RPL)U)
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,C: z,•Aer 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. Date
G7.2850 C53 64 Y
Date `1 ' `a -41 Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
bompensation, 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).
( ) I am exempt under Section , B&RC. 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.
I have and will maintain workers' compensation insurance, as required by
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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:
Carrier Policy No.
(This s(elctioht� eea-rtt'be6completed if the permit valuationMisC-foVjV&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 3700 of the Labor
Code, I shall forthwith comply with t ose provisiols.
Date: '► Applicant
Warning: Failure to secure Workers' C°� pensation coverage is unlawful and
shall subject an employer to criminal perj alties 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. V
1. Each person upon whose behalf this application is made & each person af`
whose request and for whose benefit work is performed under or pursuant to i
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
e above-mentioned property for inspection purposes.
Signature (Owner/Agent) _01,_ % :<_.a -r-'` Date }
BUILDINGPERMIT PERMIT# CONTROL#
5463
DATEVALUATION LOT 9707-029 TRACT
7/
l f/,_7S. i (1lifl
JOB SITEII i
APN
ADDRESS
VIL91 t • _1R C i
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RICHARD MOORE
GATTUSO POLL PLUMBING, INC
$5813 CONGRESSIONAL
667 EUGENE RD.
LA QUINTA CA 92253
PALM SPFUNGS CA 4-2264
(76f))327-7592 CBL# 816
USE OF PERMIT
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POOL, SIVA. ANI? `tl►A T f :Rr AIJ, (,.> NLY
p )OL ANDIOR SPA 30,000.00 LS
EITIAIATED COS r OF CONSTRc{C'noN
30,00:00
PERMIT FEE SUMMARY
PLAN CIVECK FAE I W000.439-31.12 $181.93
001.JS"1 RUCTi0W "T7 101-000-41 S-000 �?84 •SfD
MECHANICAL FEE •-171903.. 1.01-000-421-006 S24.00
ELF: TRICAL N1KE -� P001, 101.-000,17.0.000 $:15.00
PLttMf3INC1.FEE -- PC.WX I01 -000-419-M $23.00
S I'C)'l AL CON-STRU(MI ON AND PLAN CHECK
S565.43
• ESS PRT? -PAID FEES
$0.00
JUL 0 9 1997 "rOTEAL TEES NOMI
PERMIT WF,
$►565.43
,01 N, 0,F
RECEIPT
DATE
ByA
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
i
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 Wail 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 po,
Underground Pibg. Test
Final
Gas
PLUMBING APPROVALS
acTes
ec ric 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
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
Utility Notice (Perm)
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ACCEPTE®F R COINSTRUCTION
SUBJECT TO I TALLAriON AS PERA
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��� ACCEPTED FOR CUiv-S CRUCTION
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__�UBJEC-T-To STALLATION AS PER
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AND ALL APPLICABLE CODES
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