0303-087 (RPL)LICENSED CONTRACTOR DECLARATION
Thereby 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. Date
r=43 t 1 `3 B C8 AMC I Inn/0.
,t
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:
( ) 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).
( ) 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&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 workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( S 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
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier S`l"ATE, FUND Policy No. 130=6-99
(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 3700 of the Labor
Code, I shall forthwith comply with those provisions. 4!
Applicant—
Warning:
pplicant 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.
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.
l 1
Signature (Owner/Agerit) •'"t'`" E�� =' '�'� Date
BUILDING PERMIT PERMIT 0
087
DATE i �, VALUATION 47311%W'00 LOT TRACT
7 l
JOB SITE ADDRESS 49 7th? Nt,,.R0 nS,�I�.���e�`� rIS,(,)'OT '(;*
APN
OWNER
CONTRACTOR/ DESIGNER/ EN 5NEER
W(,`ME X. (1 LBS02d
JNP F't31'kmi'►7c ses
49.700 RANCHO BAN M2.l++N'CMQUITO
4.5.260 k'.t &I S;.'.
LA Q'WWI A C"ti 92253
M10 CA 92201
(760)347-0$00 (MLO 49518
USE OF PERMIT
P001—AND/OR SPA
POOUSPA, ALARMMAWUERS SHALL BE Its PIACEXY P:#2&PLAS'PRR
INSPECTION, �(?1JII�F�.�N'E' l?idC T.s�4lii� N�9'. it�CIs�JI�i�i�
MLoANWOR SRA i's
EbIm"M COST OF t°C7N's"3° EXIMO
2315W.00
I'ERNErr £r HIE SITAO?I 1t ZY
PLAN CHECK M,1 fat -OOfY-439.318 gI57.95
.
CO,NSTRUt;71'0N Md Gl -0L'0 X31$-L1GD0 $ f .it�1
MECH AN MAL M -- POOL 101-000-421-000 01.00
ELECTRICAL RIC.,At, FA, - POOL, . 10 -0 c, t $0.00
.
PLUM Ell INGFEE _ 'POOL 1003 419-� $77,0:1
�
.
:AApR.12 2003
1°1
C►FI�OA�C pEpT.
MJB- 3;y` 6L„ CO ASS'�x�.i3't,`°.t`1014 AND P%. -W CDEC:fC
$496.93
.c.W PRE -PAID MW
L*tl
T011AL PRMW FEES D-09 NOW'
$496.93
RECEIPT
DATEINSPE
BY
ti{i t,l
A
DATE FIND
�'
PR
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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
C
Bond Beam
Approval to Cover
^
Equipment Location
Underground Electric
Underground Plbg. Test f
Pfnal
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Parrs
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
— a
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Furfures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
sF'DOC_-.P"'nev^`c%^�IY'�fVP*.1 Wwo.a+r w.��.��Vlw^isai:�'vSiT _'w� YS� •=W�;
BUILDING DEPARTMENT
CITY OF LA QUINTA
OFFICE: (760) 777-7012 INSPECTION REQUESTS: (760) 77.7-7153
TO: DATE:
ADDRESS: 2-7ro R,4�.� zS -A T --,i i jc-sAi/,To
CORRECTION NOTICE
INSPECTION: PERMIT NO.:
72l� SHAGL
i /w ir:// i //iii ' A -J n -is /-7 f=v . J,-7 t'-5
Inspector
(760) 276.6408
INDIO, CA
GENERAL SPECIACATIONS
SHAPE
JET6
MICHELE 4850N
49-700 RANCHO SAND FR4NGSOUITO
LAOUINTA-GA-92253
PPROVED 6Y:
THIS DRAVVING REMAINS THE PROPERTY OF MOCALLUM
POOLS. REPRODUCTION OR UNAUTHORIZED USE
WTHOUT PERMISSION IS PROHIBITED.