9904-198 (RPL)- LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
-khapter•9 (commencing with Section 7000) of Division 3 of the Business and
04 u , Professionals Code, and my License is in full force and effect.
O C) License # Lic. Class Exp. Date
r LU LO
7211105 Olin. 0120f
I % f
oZ rI �D `� `° .t rid• Signature of Contractor •'�� % l r -
to O.
J1.— 0 OWNER -BUILDER DECLARATION
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ co License Law for the following reason:
Z ( ) 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
Y., .. contractors to construct the. project (Sec. 7044, Business & Professionals
Code).
CV)O I am exempt under Section , B&P.C. for this reason
LO
N bate Signature of Owner
O' C
CL Q WORKER'S COMPENSATION DECLARATION
ST Z
I hereby affirm under penalty.of perjury one of the following declarations:
n< cc
P. O () 1 have and will maintain a certificate of consent to self -insure for workers'
K W I.L.compensation, as provided for by Section 3700 of the Labor Code, for the
D - Q performance of the work for which this permit is issued.
n QI have and will maintain workers' compensation insurance, as required by
U
Q Section 3700 of the Labor Code, for the performance of the work for which this
i rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
7T.. Z Carrier Policy No.
0' 5
�a
"J (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
CodO shall forthwith comply with,those provisions.
,
Date: 14.4- • ��'%'Appl"icant', r x1'r'H1,l� .K. P
yv a �, .' .... '_ ..... .. _ � .
b 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
Ii 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 tot the conditions and restrictions set forth on his
application. r
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.
1,Slgnature (Owner/Agent)' Date�%�r�E+'/'�'*
BUILDING PERMIT PERMIT
#9414-
DATE . 04122(1" VALUATION S.1 2.1iE�. LOT TRACTJOB '
ADDRESS 78-600 C AR�NES' CIRCL%
APN - -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
P.UFiEN RtAVARI2.0
VALLEY POOL & SPA
78-600 CA(MES CIRCUS'
47410: E. PttLN4, C:A.N YON `'DR. #116
L.A. WN"1'A CA 92253
PALM SPRINGS CA 9228&1
(7610)779-3939 CBL# 2565
USE OF PERMIT
Pf.3OL ANEWOR SPA
P00USPi1, ONLY - ALr RNISMA RIERS .IN i 13E W PLACM AT
PRb-PI,A.N'.f'.HR. j'N;jP Yi"iQN
i?Caw ti. AtS�i1DARN. S"PA 1 0.00 I
PERTMT FET, SUMMARY
PL.NIN t:`I!l. K FH1 ,1137.73
�'! ini:4`i'12iiC'f'ic'DtJ (�'Fi"• 1f11-1)()fj.r�jti-fMf1 'tt 33 flfi
tai cl IPWICAII TITQ -- 17100l. 1 i11.00M 4*21-000
W.EC'r.K1(,A1. Ems,..- PtW)L 101-04111-420.0)
PLUMBIKO Hj E _.'"X 101-000-49.9-(N)(i $2i'.lhl
81fFi^1'�,.� L A I., 1. r-ONw31k tJC01_Y)N ! ND PUIA1`I C;IMCK
$31975
1:0;<'AL VEACM-11' #6'1'uVS WJl+:NOW
$318.75
'
I 1 1!
RECEIFRT�, DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
y OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond till
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test Cy
Final
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
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)
CITY
BU WING J,�
41)
jD-,-pARTMEA,T
Ap T
SUBJECT To
INS"I�ALLATIQN AS P,R
---------------
AND All APPLICABLE CODES
BY
---------------
D
T
;u
%D
Lq
D
3
z
n
D
U)
-4
0
;u
m
z
D
CITY OF LA O. UMTA SUB -CONTRACTOR UST
joe AtWftM 78600 CARNES CIRCLE PST *OWNERRL6-kN
on this job. Arty dgas to this list must be approved by the BenUM
ofMAdwe vwMk-for tach spofficable trade. all information
Division p11or to
below must ba
canlrleneement
-AV-ARR4 adag rvt� vAulFlr root SPA
. Only persona appearing an oft fiat or their wnpbyeaa aro authodwO to work
of work. Failure to comply will result in a stoppsga of work a WWw the voidance
cant. Vn file' is not en able
3YNb l
Gaspx; NunsCINXIIIAMOM
iaa. A. a. Cob
a
Loma» "Mw6w
IMUPWO
lip Das
bm td=O
lEap. Das
Callow 1l.en Vial taky "D ahm &W Dais tJa; "Taar
iso 90ft FUMIL CdCwo9 IFana1 0Mhwbull ha+oA bol ayaal
GARTIiYYOM IC M GATI'M POOL CW -53
CONMIFOC-al AJSTBtCONCRETE
50
8301 a
6r3OM
r3t/99
mdrH INS 996401 1/1/99 al 112 Oo
1T-05 1/19 F99 33 2 00
iilAlal�B fC•ai
.
a7muCr. avuL 1C4i11
P11N1a111D10,98i GATTl150fOOLCORP CIS3
572450
rA0099
ENrrH iNS Z 4496MI 1/'/99 91 1 2
LATH PLABM OC-9al CROWN POOL PLASTERNC C-35
427606
34/00
STATEfHND 154496-97 11123/98 191 9/1
DNYIMALL [Cal
MVAC 1C-1
CLEC MMML M101 GATT= POOL CORP A
rrzM fi
30M z
MTN NS 996441 1/1139 816 t a2
ROOF MO1C-M
SHEET MWAL We"
ROOlrl4llrlal . '
OtAMO 10-11!
aw"Towl 00-A
SWAM DaIR Ic AA
RAWMG OC �3l
Ca11AM■C:RE A.•ssl
CAlDETi IC4i1
FIMICM IC -131
uwmw,vm r,=
POOL J 8 L GUWE
Rfbnff
MIS m 761430.01 9/1!h! 2�