9710-081 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
'i!'Chapter 9 (commencing with Section 7000) of DivisioK3tof the Business and DATE
; PrSfes;boonals Code, and my License is in full force and effect.
License # Lic. Class f, _Ezp. Q to e
,.
'i 1814
/Date, Signature of Contractor
OWNER -BUILDER DECLAI
JOB SITE
ADDRESS
1197
I.V / I OWNER
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.
f A'CE'h'l1NlJ
(This section need not be completed if the permit v
() I certify that in the performance of the work.'!
I shall not employ any personin-any,Tanner�so
workers' compensation lavas of California, -and a
subject to the workers' compensation provisions
Cgde, I shall f9rthwith comply with those pr.vlsioi
ate: i��`Applicant--- t1
BUILDING PERMIT PERMIT#
VALUATION LOT 9710--08I TRACT
10117/97 S.00
78-725 SAGEBRUSH
CINDY PIPER
,8-7215 SAGEBRUSH
L.A. QUINCA
USE OF PERMIT
APN
CONTRACTOR/DESIGNER/ENGINEER
CONTROL#
6048
AMERICAN POOL COAISTRUC17ION
68575 SHIN FELIPE RD.
CA 922 CATHEDRAL CITY CA 92234
(769)329-2156 CUP 1104
SUPPLEMENTAL 1313 -MIT FOR PIF,. MIT #9704)7, RERffAGE POOLS
WrrHDRAWN AS CONTRACTOR.
)3480;-97 113TINIXYE1D COST OF CONSTRLIC ION
for $100.00 or less). PERMIT FEE SUll IVLARY
his permit is issued,
,lime subject to the
`if I -should become
i&00 of the Labor
Warning: Failure to secure Workers' Compensation coverage't uunlawful 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 willf 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
e above-mentioned property for inspection1purpdses:
I
/Signature (Owner/Agent) �'�'°��{� s Date 16 1_(_1
C1T� ®F LP, aUgTA
e
21Si1�IWTAL COINSTRCICCION AND PLAN C14ECK
OC1 LESS PRE -PAID FEES
TOTAL PERMIT FRES DUE NOW
:1
RECEIPT I DATE I BY ,f I DATE FINALED I INSPECTOR
0.00
$4100
$0.00
50.40
INSPECTION RECORD
,1
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
Bond Beam
Main Drain
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 Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
,
OCT -14-97 TUE 15:24 6196609121 P. 01
C17Y C)�
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OCT 15 RECD
AM is
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11434 Shadow Ranch Road La Mesa, CA 91941 (619) 660-9121
Licl C-53.495843