0107-153 (RPL)LICENSED CONTRACTOR DECLARATION
hereby 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 # I Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
1, as owner of the property, or my employees with wages as their sole
pompensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code),
( ) 1, 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.
(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.
Date: Applicant
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 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.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT r t ! f ;. i 3;: TRACT
JOB SITE
AWN
ADDRESS
A-4-d-W CALLIc SAITZEA 11.ARTGA'K ,
- -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
i' fa WARD MAKR(W
r -AN-I.R BUi Rik
BEd • :�$0 t'•'AUX 3KVFA DART APP,
USE OF PERMIT
0XILANI V{lR
>'^tVIAPR. ONLY . A:J,ARMWIiA IRRN' MI1.3T lair IN Pl;M:t., T
PI?%.LAST'FF IH';PWT[ON - 11001,;:HO13,10►i0.'NOT IN(YLt30KI
i'001. Ak WOk OP A 1 iMA.011 I;)
P'ARMIT Ir'7I'E ail MPAARN
4'I.AA C�Wt`K RYY 101 XXV14 49. 3'1 S 09.0
{'r)tl 'PR= J(' 1 IC313 i+LF I s] I-+`�i<)•.1 i fS-[7i1[► i'�;1, �1
M CIS NNIC:�4.[., FEE • P001. 103 ' C► O-471 •[kw $240
M1!'.l^.TttiL.A11. F?X •• 11100L 101-( 04—d20494 Vs.as
11 •{Mf3NG YKF .. M)L i C,l-WP-419-000 3117.00
7'Illl 04} ttElf"fi[)?! A'[]{]3'iA.l7t}II1+C`1:
V4(4.45
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l I F011 PRF.•PAW nPR
SUMU
r' r
RECEIPT--_ _ - '�,RTE
BY
DATE FINALED
INSPECTOR
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
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
(% —
COMMENTS:
i
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)
M
OWNER/BUILDER 'INFORMATION
Dear Property Owner:
An application for a;building permir.;has been submitted in, your name listing;,yourself as the builder of the property
improvements specified.
For your protection you should`be aware that as '',Owner/Bu lder you are the responsible party of record on such a
permit. Building permits are not. requiredao,be signed by,property owners unless They are personally performing their
own work. If your work is beingperformed by someone other'tban yourself, you may :protect yourself from possible
liability if that personapplies, for the proper permii m his or tier name.
Contractors are required by law to be licensed"and bot ded'by'the State of Cal ifornia.and"to•'have a business license
from the City or County. They are also required bylaw to. Pyr'their license number on, all permits for which they
apply.
If you plan to do your own work, with'the exception, of .various, trades that you plan to°subcontract, you should be
aware of the following information foc'your:benefit and,proiection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.60 or. more or, the enure pioject _,and such persons are not licensed as contractors or
subcontractors, then you may be an,employer.
If you are an employer, you must register with the`State;and.Fedeial Government,as an employeuand you are subject
to several obligations -including Siate`and Federal income tax`,withholding __federal -'social security taxes, worker's
compensation insurance, disability.insurance,costs and;unemployment compensation contributions.
,.
There may be financialtisksfor you if.you do not carry but these obligaiions,.and these risks'are especially serious with
respect to worker's compensation instiiance
For more specific information about your�obligadbris under Federal Law;, contact the Internal Revenue Service (and, if
you wish, the U.S. Small: Busiriess Ad'minstration) For more specific information abou your obligations under State
Law, contact the Department of Benefit:Paymenis'and the DivisioirofIiidustrial Accidents::
If the structure. is intended for sale 'property owners who:are not licensed'contractors are,allowed to.perform their
work personally or, through' their. own employees', without.a licensed,contraetor,orsubcontractor, only under limited
conditions.
A frequent practice of unlicensed personsprofessing. to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the 'property, owner: is pi6viding his or her own labor and .material ,personally.
Building permits are not required to be `signed.; by property owners unless `they`:are performing their own work
personally.
Information about license'dcontractors,may be obtained' l y contacting the C6ritractors''State License Board in your
community or at 1020 N: Street, Sacramento; California 95814 ``' ;
Please complete and return the. enclosed owner-bu,ildei:yerification form so that we can confirm that you are aware of
these matters. The building permit will,not be issue d"until ahe verification is returned.
Very truly yours,
CITY OF.LA QUINTA
DEPT. OF. BUILDING AND -SAFETY
78-495'Calle Tampico
La Quinta, CA 92253
(760)777-7012
n10)777-7 1 '
OWNER'S SIGNATURE/ ATE
PROPERTY ADDRESS
PERMIT NUMBER(s)
o i� s• Ur
--j
In
CITY OF LAUUIw1H
BUILDING & SAFETY DEPT.
APPROVED
FOR CON TRUCTION
DATE77
GQU%f %a cee►��R—
fe-offW1
CONTRACTOR cannot assume responsibility for
damage to curbs, sidewalks, driveways, cement
slabs; sewers, lawns, trees, fences. retaining walls,
sprinklers, telephone lines or shrubs. Name: EDDIE MARMJO
When access is made through a neighbor's property
it is understood that you, the owner, have that Address:
neighbor's permission and assume full responsibility. ��- 5�p Cg. �E data $r,RBAe.A
City:
vPsoozo.dwg TRACT: SONRISA LOT# 14
VACATION POOLS & SPAS
9522 Donaldson Road
Luceme Valley, CA 92356
(760) 248-8045 phone
(760) 248-2919 fax
Lic.#C-53-351673
Sales Locations
Bermuda Dunes, Irvine,
California City, Rialto,
Lucerne Valley
(800) 999-1811
GENERAL SPECIFICATIONS
SIZE I X 3 '
AREA PERIMETER
DEPTH 3 ' — S '
TILE CHOICE SO.
RBB.
POOL CAPACITY
GALS
MOTOR HP
HP
MOTOR HP
HP
FILTER
SO FT
HEATER SIZE
BTU
CHECK VALVE
GASLINE BY
FT
POOL LIGHT
CLOCK
ELECTRICAL BY
FT
AUTO CLEANER
CHEM. FEEDER
PLASTER COLOR
DECK BY
so
DECK TYPE
SPA SPECS.
SIZE '7 ' . RAISED 18 "
LITE VAS WATTS
DUAL LEVEL SEATS
DAMWALL I a- q
SPILLWAY SIZE la f X 30 "
DATE SPILLWAY 30" W, OF
#JETS .-
DATE
SIGNATURE