0008-087 (RPL)LICENSED CONTRACTOR DECLARATION
I �herreby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (co ; jAeneing with Section 7000) of Division 3 of the Business and
P'rofessiontiG Ude, and my License is in full force and effect.
'k �u�"ceense # Lic. Class Exp. Date
f376S C53 B HCC
Date % ' ZeW'Signature of Contractor
OWNER -BUILDER DECLARATION
12,13112(
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 FUND 'i Policy No. 12M96.00
(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,
Tshall not employ any person in any manner so as to become subject to the
workers' corripensation,taws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I hall forthwith comply with thoseeprovisio6
Date: m.:; z, Applicant ewf
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. t r
1. Each person upon`whose behalf this application is made & each person 11 at
whose request and for whose benefit work is performed under or pursuant to 7V
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}}
work is not commenced within 180 days from date of issuance of sU
permit, or cessation of work for 180 days will subject permit to cancellat on./?
kv
I certify that I have read this application and state that the above informaYO i -
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and, hereby,,authorize representatives of this City to enter upon
the above-mentioned property forrinin/spect�Ionn pp poses. g
Signature (Owner/Agent)../IM=l✓cx.— ;, Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT: "ry •TRACT. ,
JOB SITE`
APN
ADDRESS 48-7W S.AN. PF.DRO
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ON
Wk-8MRN FOOLS, -
48.700 SAN P1?DR0 ` , ,
43375 MADIBON a9i'
LA QUINA CA 92253
LAIC) CA 92202
(760)347•5959 MLO 1151
USE OF PERMIT
POOL AAiIZ OR SPA,
POOL & SIVA ONLY•ALARMSI ARRIEPtS SHALL. 13E IN PLACE AT
PRE-l'IASUR INSPECTION, PERMIT DOES NOT INCLUDE BLOCK WAaL 6
FOP EQUIPMENT 04CLOSURE
VALUATION 20.000,00 L9
XSTn"T= COST OF CONSMUCTION
20,000.00
PXRhW FU SOMMARY
PL&H C HEeK FE'E 141.000.439.818 $134.51
CONSTRUCTION bra, 101-000-418-000 UV.00.
MECHMICAaL PER -- POOL 101.000.421.000 S24,00
LLECTRIG,AL me •. POOL 10 n -000-420-000 $45.00
MIXIM. Broo FEF.. -- Pool" 101 _000-419.101m, $27,00
.G
t
i
1�
SUB- COX UPON AMD PLA14 CBECK.
$437.55
N15. ; LMS PRE -PAR) P
$0,00
U 3 200,TOTE PF-' �>ca�v
$4.37-55
AUG ®"
of .uk ti r T
RECEIPT
It,
DATE f
BY ' f
DATE FINALED
INSPECTOR
F7
•
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Setlacks
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
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
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:
-
WESTERN POOLS
P. O. Box 1047
Indio, CA 92201
MORNINGWIMH OVEN MSTR�
ROOM BR
yg7200
KITCHEN 101$1. _! 'A V _S7
�,•`•. ' • ' . _
M0� y -�xr S70W
Z.101-.66...: 1 r
1.01:66 1
{ 7 _s"-' PAD P TIO
CL 0.2.0° F p
O
O o :�
O BR #2 GREAT RM
s 101.58 EXISTING WALL
POOL DECK "
' S -6 WALL
OL
I FJP
ENTRY CITY OF LA Q U I N TA
BUILDING & SAFETY DEPT.
SM,
100 �2���/s" APPROVED
5A,4 vines .: o00 �� �:
o a � SEPTIC �.= ' cTE " FOR CONSTRUCTION
TANK �n.rcia
12 OT. I'�-
SPA DATE oo BY
Mi,4
II' - POOL
.. / .. ::.:.. EQUIP
12" HIGH PLANTER ,
I ! : 5'-6" WALL
PIT11 P
t\—OMIT BLOCK NEW 5'-6" WALL OMIT BLOCK
G ,
_ 10U:58��� � PLamp
.
s.j
104.00 °—
100.58
CURB LINE