9804-104 (RPL)LICENSED CONTRACTOR DECLARATION-," .
l 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 # Lic. Class Exp. Date
y"i"p.
' 67
7�` C-53 C-8
Date fel f Signature of Contractor
I
OWNER -BUILDER DECLARATION .
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).
O 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.
oj;fjilrhave 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.
oi1'r�CE F"i3N13 lata -9'i-0010325
(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.;l agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to"enter upon
woe
`,the above-mentioned propertyfor inspection p
Signature (Owner/Agent)/-`"< Date
' f
BUILDING PERMIT
DATE VALUATION LOT
4f15f9� $14,500.00
JOB SITE
ADDRESS
43-621 PALERMO COURT
ROGER SNELI.ENBERGER & ASSOC.,
78615 NAPLES DRIVE
L,A QTANTA. CA '92253
USE OF
PERMIT# ' CONTROL#
.9804404. TRACT
8,798
CONTRACTOR/DESIGNER/ENGINEER
t;
G. R. PU{. t, C ONSTRIJCWN
68-46-5 PV.'kEZ RD
CATHEDRAL CYR,' CA 92214
760)328-2651 Cf31,*# 69
F
POOLiaPA WN,. AL 4k&ir;iFa �ft�cii f't� r�ici� T0.011 UP M- A T f 0NAL' ;P1u().R
'C� .l�N-Gf3Pfi�121•f�,t. �IST'ER :II�tiP[:E'1"lOT�
,NOOL AAiDIOR SPA. _ 14, 500.00 LS
L '1"C�T!�i. CSJIv' T1tt,TC'l.IUN �1N13 PL ii�t G1fL•'Ci:
ESTIMATED COST Or, CONS-D'A3UtJUXIN
1€,5,i1P:d;4
FIEP,AffT FES: SUMMARY
PLAN CHECK HE
101-000-439-318
$105.30
CONSTRUIL-f IGN FEE
101-000-413-000
162.Ofl
M1=.CHANIC'A;LFE�E: P OL
101-000-4x1-U1J0
$?21.00
'ELECTIUCAL FEE - P06L
101.000-420-000
$45,00
1 PL UM1 INO f~VE -- POOL
1.01-000-419-000
$27.00
$36-00
1998 f ESS .PRE-VAID PEES 50.00
`�� 0 .,u,1'E:�2mIT FEES D4J1N NOW $363.:30
9 CAI
*�
OV G.ft
ECEIPT- DATE, BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHAN)CAL APPROVALS
Set Backs
Underground Ducts
Forms & FLootings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof DeCR
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
Z
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)
j
COMMENTS:
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01
13
PLAN. 3B(R)
lb! �I
'99,
BELLA VISTA,. PHASE 2
E
SCALE :'1/16' j i"-0•
-LOT 13
-0•
E
SCALE :'1/16' j i"-0•
-LOT 13
CITY OF L
'CovorrIONALLY
Tptkjc-noN
ACCEPTED TEJ) FOR CONS
SUBJECT TO iNSTALLA-f lot' "S pe"
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