9802-069 (RPL)LICENSED. CONTRACTOR DECLARATION
I I?ereby 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
427470 x.:53 9/30198
Date Signature of Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Licens -Uaw for the following reason:
4.lr''I, as owner of the property, or my employees with wages as their sole
t 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.
��, knave 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.
�i'iia"I`F FiIMD 134ZOO-97
(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 uJh tf os�►pJ�ovisions.
Date: •- Vii,. pplicant• // of imp
Warning: Failure to secure WOTIZers' 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 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. Anypermit 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 complyIth }all City, �annd State laws relating to the building
construction, and hereby Ithorize representatives of this City to enter upon
the above-mentioned propAy for inspeotib , urposes.
Signature (Owner/Agent). Dat
PERMIT 1i °°"^;rR°r`"
BUILDING PERMIT
qq
DATE VALUATION LOT - � x^i�i3(9 TRACT 6 cJ 8 5 .
&20,000.00 _
JOB SITE
ADDRESS
APN
48-711 SAN V11YCMI
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C14UCK KNOXPO.RTEWS
POOLS & SPASiNIC
48-211 SAN VENTE
307 CAAJ YON V1EW.D9JNrC
LA.QC11NTA C:A. (92253
CALINIESrt CA 92320
(909Y797-0'tI CK 50"
USE OF PERMIT
Ul'1fl't
.
P00USPA ONLY ALARMBARR MS TO M OPFRAT.I.ONAL P 12%68 TO
F.N_C Pi PRE-PLAS MR NSPECT.ION
POOL AND/Olk AND/CitSPA �O,i�00.Ofi i,S
1{STIMATC1) L'°b t OF CONSTRUC1<lt)N
20,0o0.00
PERMIT FEF SUi M-kRY
MAN CHECK FEE 101-000.439-318 $1.31.55
C€7NSTRUMONFEE $207.00
NIECHANTCAL M, -.- POOL 101-OM421-000 $24.00
EL> C'TRICAL PEE - POOL, 101 -OW -420-000 $45.00
A 1
PL;UN1131NO FRE -- POJOf, 103 -000-11 ON S27.00
Vim
F'EB 18 19
8
<ow:_e
_
1
�l
SL&MT.t'�1. CONSTRLICIION ,A.Np PLELN CFIECIZ•
3437.55
MESS P1tE-PAID FECS
$019)
TOTAL 1PERNI T FEES DUE NM'
$437.55
RECEIPT
D E E
By �'/!
DATE FINALED
INSPECTOR
l<.
Iq
INSPECTION RECORD
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 elll'71 7r
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test P17, A
Final I I
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
Fcdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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AUG -20-98 THU 10:15 AM TERRACINR' GRTHO
max -7c.Qd -- +17117 ---701(
Attn: City of La Quinta
Building & Safety Department
Attn: Mark Harold
Permit #9802-069
Chuck Knox
48-711 San Vincente
EKE NO 909988/49 P.1 w \
-Y
.i
August 20, 1998'
Due to the builder of the house we will be in need of an extension
on the permit at above address. Please grant this extension. Any
questions please contact: Dave Porter, Potter's Pool & Spa. Mobile
phone #909-262-3322.
Thank you,
Dave Porter