0205-024 (RPL)r LICENSED'C.ONTRACTOR DECLARATION
4p� I hereby affirm urider,$ nalty of perjury that I am licensed under provisions of
Chapter 9 (commencmg'With Section 7000) of Division 3 of the Business and
C14 U)
Professionals Code, and my License is in full force and effect.
r-, cry License # y Lic. Class Exp. Date
552140 C53 B MIC 1/2(
i
,Date "=" ' ` - Signature of Contractor',
Ve OWNER -BUILDER DEC, ARATION
,/
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.
(� l I have and will maintain workers' compensation insurance, as required by
Se lion 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 9T.AJ'p. Ff314O Policy No. 162"163.111
(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.
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 ata
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.
ignature (Owner/Agent) fl 1w • Date rc•
BUILDING PERMIT • PERMIT#
Wk 03x9
DATE VALUATION �i"1000.00 LOT TRACT
�7�.
S, 3,
JOB SITE
ADDRESS $� !} ��dA��Ca(i;T
APN '
OWNER
CONTRACTOR / DESIGNER / EN (NEER
w3::1SKOP' ' PA INHRs, LLC
GAL PAC. P001A
55.920 PGABLVD,
P.01 BOXI804
LAQ�MTA, CA 92253
IsltLIA81PRTRGS CA 92263
cmh 6'119
USE OF PERMIT
POOL PJW10R 111PA
P001JSPA, ,F LA.,RM.RMAk7,RIERS SHALL SE IN PLACF, PRIOR 't O
P tF,KA; TER INSPit' MION,
100L A,14 IOR. SPA, 30600.00 18
k✓our of 4-.Lfl"f1i'A.R,44'✓ M_ On
eimP�S.i°,.iQJ,0
c! `` ��jj � �'}${'�j'f.'.yJ�XfS}1,AJ.i�di'41.P�d'.•�i/
PWT CFJF:(,K: FEE 101.000-439»318 6184,83
CONS'1'It.I.IdTION IvFr, 101-000-418-000 VFA.50
MECk' ANICAL ME— POOL 101.000.421.000 $24,00
L).i'.+~" R.ICAL F°ITE — PC*L 101.000••420-000 $43.1041
PLUMBING FM-• POOL '101-000.419.000
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SUB TL'�7�AL CO °,C,f�.i1(11G3k3 MID LaT AM C1W�'�
U0114 YU-PAW FEW
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& ALRY-faaff m1:81MENOW
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Mt3 1002
CITYOFLAQUINTA
FlI�4NCEDEPT.
RECEIPT
_`F
BY +y'
DATE F A INSPE R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 7.
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
F�O�
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
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
_ _
-4V
J��Q�
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)
npr 26 02 08:14a The Summit
at PGn
West
(760)777-8789 p.1
APR -25-2002 THU 02:35 PM KSL DEVELOPMENT
CORP
FAX NO.
750 5848090 P. 03/03
DEVELOPMENT CORPORATION
April 25, 2002
Soutllcnl Hills Devclopmcnt, Inc.
Aucntion: John Read
55-161 Southcni Hills
La Quinti, CA 92406
RE: Pool Plans, Lot 59, d:ltcd February 28, 2002
Dcar jollll:
Lipon review of (he above relbrenced Plans, the 11111roval is for digging the pool o),ly.
Whwl Cindy/.,irnorez returns, she will review for rnal approval.
If you have my questions, please advise.
Very truly y ur
W llliorn J. Doddt
Semor Vice Prosidcoi
WJ911S
cc: Cindy 7.nnl0,11C .
55.920 PGA Boulevard • La Quinta, CA 9225.3 • (760) 564.7166 • Fax (760) 564.7131
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