0208-152 (RPL)LICENSED CONTRACTOR DECLARATION
I 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 # Lic. Class Exp. Date
656128 C-53MIC1fi,� l/fio
Date Signature of Contractors-�'a,
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
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 STATE C""OMP 3AT1 Policy No. 040 0041611-01
(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 wit ht ose provisions.`
Date: O 4? Applica Pt
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.
Signature (Owner/Agent) .'�'. f • ;+ Date�� s
PERMIT #
BUILDING PERMIT
�,�._.._...
Di...t VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Iva, MWOR :QRS. M. RMM
CALWOMA POOLS 4(k 8PAS (COP MAN CO.
3 5 1-900 P:QJM3i M r; q
Of, I (Y) .r's,'JE1 UF, 5.4
LA Qi: WTA CIS. 92253
C+::+AC1�Ti LA CA 92236
(760)39-9222 CEU, 00355
USE OF PERMIT
POOL.,€ MINOR `SOPA
IPOOLa'SPik AI.s9.12M1,�.',lSARRI.L0 SHALL BE IN PLACE AT Nl?&P":ia,€r.S". ER
INSPECTION, EQUiptMFNTFNCiASfx1,EW4:�TINCL.IJDEO ,Y
POOL AND/OR W?A 11,0100AM LE
:SEM&tJXD i;0YJr OF r'0Hff1VUC'1J0X
P1tMIMT A'R'E SUMMARY
PLAN C3•IECX 79E 101-000.439-318
CONI" CRUC c1ON I`= 101-001'1"418-000 1;186.00
ML+CIIr' LAICAL FF21-- POOL 101-000Q4.211�OMD $24.00
.
ELKCTRICf#I..FEE •- POOL 101-000-42 -000
PLEIA��MO ME - POOL 101 -000-419-MO $27.09
r
'h SUF.Yid\.,.f`�.A•L�.ONol.Gd�4.%i,�ddO�'@61d�7•i�3�.LA�!C•1..d��SG!+i+14.
IMS T112RE4 ES
UMI
�JPKI&. YKES xir. F1 NO �2CITY
:7:TaL
OF LAQUIN
FINANCE OEPT
RECEI15A
,BY
E FI LE �O>
,
INS CTORgg
tp',
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
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
al
ja
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
1*7
Sewer Connection
Encapsulation��—
Gas Piping
Gas Test
Appliances
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
i
Final
Utility Notice (Perm)
_
_
_
Final�� , C�
COMMENTS: v—
i
FROM :
SENT
9
P(I
NI
ORNIA POOLS AND SPAS '
'GA WEST P.EGT09NT-'AL A680C, 1;
TIAL ASSOCIATION, INC
%ugust 6, 2002
Uonxo and Kd ine Foreman
+5=460 Pz�trst
.a Quints; CA 92253
)ear Mr, and btrs. Foreman,
PHONE NO. 7603465407 Aug. 16 2002 06:55AIl P2
760 771 5125; AUG 6 D2 4:OOPU1; PAGE 2!'
dlr. Don Adolph, Architect M Committee: MembeT, has approved your plans to build a pool at
i5-900 Pinchi rntiu si coenl upon your prodding the.following.
• The homeowner or contractor will*ded to meet with the irrigation department before
begtunn� work.
• Pleas contact Bill Bobbitt, [.andscepe''MmIW reg"rig-tree removal'atid repiacetnent-
• Property line location is the responsibility of the homeowner.
• Pool egtupmmnt will need a short iA► I installed around it to block any view of the
equipment.
we reserve the right to make a finel inspect:en'of this. change to make slue that it matches the
,riginnai ie9uest, Aa apgroval'is i only;on the-4csuheiic's of your propos plan and should not
)e taken as any cerdticatton as to the conehvctWo. woithiriess or stxucturat integrity of the proposed
we appreciate your cooperation in submitting this request for -approval. It. 1 may be of turthsr
asssstartce, please`acntact me at the H4.A office; (760) .77i'-1234; Extension 15.
3incaely
C
all
)perations Manager'
m: AnWiectuml Committee .
P0.8wx 1oW. La Cuinta, Cetibt WO2263, Telephom 76o-771.1234 FAX"700-771-5125