0106-329 (RPL)LICENSED CONTRACTOR DECLARATION
(.hereby 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 # t Lic. Class Exp. Date
r �✓ "%. V
Date Signature of Contractor�f��--� _ • •.E.y. -�''� rte,,
R -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
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.
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 Policy No.
SITA`1•H WND 161.3074-01
(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 with4 ose provisions.
Date. K ? Applicaf
""Warning Failur--ulf6-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�p`roperty for inspection purposes.
Signature (Owner/Agent) +•-' 4k l ^ a.
BUILDING PERMIT PERMIT#X
DATE f VALUAIIJON LOT TRACT
JOB SITE a N
APN
ADDRESS
OWNER `�`
CONTRACTOR / DESIGNER / EN INEER
JOS" RORMfaN
C7:A°A i use PCS .)T.Pu`3vw.a�1C,, WC
79400 :OXY ?01)M RR
60 O;iJGUIM. RD.
L1%Qmxm CA 9 253
PALMinns Cala. 922&t
0, 60)32 i 7592 fflju, h 9165
USE OF PERMIT
POOL .f`WYOR SPA
POOL hS PA ON PERM 1;' n; OF + N 0 T VNIk.,i:`.f,i 0Z SLOCK, WALI.. POOL
,AJ.AiKS .f PI MUIRET.2 TO BE MULLED PRIOR TO PIM -PIASTER
AST. R
��' E'1"C7'10Ya
P60L.r NIXOR SPA 11.,000,09 t'a
EF.r?. A`.it'.D COST OF CONtw'.1`2 UCIFION
.t.il,G�Til.I
MAN CHLICY. Ist 101100-439-313 R
x."ON �TItUC°' ION ft -W- 101- 0-013.000 $12fi,1?C
M'LCHMICAL WE -^ POOL, � 101 -0,00.421. 00 M.0n
IUAX'TR CAL, VZP,, -- POOL l p.1070 90 420-•000 $43.00
PUilARNO; FEE Fool., l0'1'-0, 00-4i.9t1 O- $71.00
JUN
26 2001
Cin OF
R1k40AX. C.O1 '� rYC"�, ' I � lr A
03.90
..
P'.
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n
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RECEIPT
DATED `�
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground'Ducts
j
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
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
Lf
PLUMBING APPROVALS
Gas Test
Electr' `Final
Waste lines
Heater Final
t
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
%
power Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
1�, f
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)
F
.® CITY OF LA QUINTA ?
�FboF� BUILDING & SAFETY DEPARTMENT _
777-7012
INSPECTION REQUEST LINE .
777-7153
4
Owner JON BOR DON
Contractor GATTUSO POOL, PLUMBING INC.
I
Permit Number 0106-329
POST ON JOB IN CONSPICUOUS PLACE ,
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-400 PASEO DEL REY
JOB ADDRESS
POOL /SPA ONLY, PERMIT DOES NOT INLCUDE BLOCK
WALL. POOL ALARMS ARE REQUIRED TO BE
INSTALLED PRIOR TO PRE -PLASTER INSPECTION
- � �PJr��"�E.vr Joh G4rLa f
TYPE OF INSPECTION DATE INSP. `
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM '6,q In
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEESIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT.POIJR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST ,
HEATING & VENT-A/Ct
FIREPLACE
> ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
a FRAMING
INSULATION
'PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED r '
DRYWALL INTERIOR x
EXTERIOR LATH
POOL PRE PLASTER V
POOL FENCE & GATE
SEWER SEPTIC TANK
j - •
FINALS _
ELECTRICAL'
PLUMBING
FINAL GAS TEST
HEATING - A/C-
TEMP
/C
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT 1
TURN ON UTILITIES OR OCCUPY BUILDING