0105-195 (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
„x
�5t31 xE3 . •- ' C.`5:� ��ZG""- � : EYl';� 1 /aC
Date�,'°� Signature of Contractor—
I,y'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury tlat 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.'. .
(w,�) -I have and will maintain workers' compensation insurance, as required by
S'ebtion 3700 of the Labor .,ode, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
�1',�.°1"1? 3i+ht';E�3V�.�h'�I i�46�d►41G':��
:?-(This_ section heed not be completed if the permit valuation is for $100.00 or less).
r (,) 1 certify3hat 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
Codesh II forthwith comply with f3e prgvls,o�`ts. f
Date... $ Applicant 1 # AI . d
Warning: Failure to secure Workers' Compensation coverage is unand
shall subject an employer to criminal penalties and civil fines up to $
addition to the cost of compensation, damages as provided for in SeJ?3 06
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building lid Sa ty
for a permit subject to the conditions and restrictions set fo h on INS
application.
1. Each person upon whose behalf this application is made & eact person at
whose request and for whose benefit work is performed under or
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 authoIze representatives of this City to enter upon
the above-mentioned properto3 inspection purposes.
Signature (Owner/Agent) . " - 'r Date /-. 43
t
M
BUILDING PERMIT PERMIT#
DATE VALUATION LOT y j_ga, TRACT
STUMA)
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR /DESIGNER / EN (NEER
CA T XYz itJiA P00.8 & SPAS P M CO
P,O, BOX 1716
747 5 JfaM10: 9, OL7ErS iffy
-dA M53
PALMDESERT CIA 92260
(760)340-9000 0114 333
USE OF PERMIT
Pool, ANc IDR 91'.x.
PO4, USPA 1IQ W. 59 1905..Ad',.ARNOSYRA.3?hlEkS Sk3ArL-1. U TE4
1'UMN ,F 7 PPY_,ES€ 4.8TK`R 11UMC;1(."OK POOL, YPQUf•PMaW rwU)SURF.
�'C�'o' f'13if2d:9�tiA9'3. .
us
,
�•gr OF c�O:�t'���ts�� : ON
X: 160.00
y�/� t�1�,8� �v �7A^c�M p���6 y���STMVIVI)
�F .raP.14C.}.7':R.II�B V72 65'atJ`A.Y51x/JYAM? .
PIAN C:;~ECK FEE 101-000,4319-318 $1",95
WXS 1113C,11UN 'i+'PE 10 t -000-41 P.,000 VA -3.00
J0�F,,� HA1A1CAL VEZ -- PA3K)1, 101-000-421-000 $$'24,/00
Ld,L,XiAw� ! [IJU.4..F'f.'a!'" — POOL 101 `M41-4f.'!,i"8J"i gW J.00
.
PLUMBING FEE -- pool, 101.000-r19=000 Ir.00
A 0
AY 6 2001
ITY OF LA OUINTA r.
FINAN5 DEPT
1501,- 4a! L Ct'9NSTRl'st�,`�iOk3A'SL51aWU3.1?V_K
$496.95
RECEIPT
DATE., i
4"
BY.-
DATE FINALED
INSPECTOR
f'l (. : '.
!_ A
r
V-.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
I
Slab Grade
Return Air
i(
Steel
Combustion Air
I
Roof Deck
Exhaust Fans
[
O.K. to Wrap
F.A.U.
[
Framing
Compressor
I
Insulation
Vents
t
Fireplace P.L.
Grills
[
Fireplace T.O.
Fans & Controls
;
Party Wall Insulation
Condensate Lines
Party Wall Firewall
[
Exterior Lath
[
Drywall - Int. Lath
I
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Footings
Electric Bond
Main Drain
Bond Beam
Approval to Cover
$/
Equipment Location
( ;
Underground Electric
Underground Plbg. Test
�- Q
Final
Gas Piping
;
PLUMBING APPROVALS
Gas Test
I
Electric Final
I
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
i
Shower Pans
O.K. for Finish Plaster
[
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
/
�� /Q�
Gas Piping
GGG
Gas Test
i
Appliances
Final/gyp/Z
i
G
COMMENTS:
Final
I
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit _
Rough Wiring
Low Voltage Wiring
R
Fixtures
j
Main Service
Sub Panels
i
Exterior Receptacles
I
G. F.1.
I
Smoke Detecit's
I
Temp. Use of Power
. g
F
Final
r
Utility Notice (Perm)
I