0203-355 (RPL)LICENSED CONTRACTOR DECLARATION
Ihereby 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. 11 f
License # Lic. Class �;Exp'eDate
i2 3jf9s�
C-53 Hul
Date- -' y 44� 1 nature 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:
( ) 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 contractinq with licensed
contractors to construct the project (Sec.: 7044, Business & Professionals
Code).
( )' I am exempt'bnder Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
1 -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 .!'� i, / s Policy No. T
(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 asAo become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation.provisloepsfbf�Section 3700 of the Labor
Code, 1 sh 1,f�!Iw(ith comply witf�ote/prouisions. f
Dat,:rb'..�1/ Applicari`t '%t �7 - ...• , w.. e -�
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� ity, and Sta'teflaws relating to the building
construction, and hereby horize representatives of this City to enter upori
the above mentioned prope rt or Inspectiop,purposes.
�a ?:K:
Signature (Owner/Ag t),"'�-�"�Date'�?
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
79-459 CALT4R' .,M1.AL .T0
.OWNER
CONTRACTOR DESIGNER EN INEER
WMf . IrS. PIANO
YpYU, ItCVOLT &.q,PA
79-4$9 CAS ATZ MMTO
4741 O X I?ALM C ANY'Oi4 J3R"141) 6
LAQLT1NLA CA 91W
P�'.}�+d.3>J/5�.;3PR+�ipy,�fi7fCis CA 92,4464 ..
'
USE OF PERMIT
POC& PACdR RPA
•.
SPA:.A,1.."MuMA.1d.1•L'IERS SHALL BE IN PLAC;U AT i+PJ,aPWk S` FR.
%NSz'C?L t ff;AkL POOL F.0 NCLi DED,
VALUATION 1.01
ESTIE�*LA. ED C;E'h`r170V C01`d;4.�'.i UCTIO N
1�Y,#�3 km
�''�''p�
PRE90-'�';) f. i� ESE i��. MMARY
PLAN CR CK AI01-0,00-439.3.18 MRS
yONS.TRilCTIM ErF.R, 101-000-418-000 Qi.IIVID
VIHANI ::€ L ME -- POOL 101-000421-000 3210
VACTRIC,AL E— c-'.af; L 101-000-420-000
i' aL(JMUYNl'3 FRIT,.- POOL 101-000-419.000 VVICt1
ILL B-TOTM,. CON�'XRMMON AND A«Aa43' CHECK
LEOS YRE-PAID ,17M3
t , U
$D.00
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RECEIPT
DATE- ;0 f �/_
BY.��.
E DNAD"OINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPA$
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
- L
Underground Plbg. Test
t
Final
Gas Piping
L
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
Gas Piping
Encapsulation
Gas Test
— —
Appliances
- — - - - —
Final
COMMENTS:
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)
MAR -25-02
06:24 AM' NHF CASTORENA
i2
e
is
VALLEY POOL,& SPA
DESIGN & coNsniucizoN
4741C E. Palm Can
,wn, Ste 116
Palm Springs, Co. 922K4
MAR -25-02 06:25 AM NHF CASTORENA 760 772 5860 P.03
� R
R
' CITY OF LA QUINTA '
SUB -LIST
s { . 4741 C PALM CANYON, f
PALM SPRINGS
VALLEY POOL &SPA ADDRESS
,
JOB ADDRESS 79459 CALLEPAL
M iAdth the Building InaWlion Card at all times
luty of the General Contractor or the Owner/Builder to monitor the sut - o tr``',;'
the same persons performing the work. Any changes to this list must be epp
11, lr to Department of Building & Safety prior to work being performed by a Cha
1►t:. ': allure to comply will result in a stoppage of work and/or the voidance of building
.: aUF('4ftdOR'S TYPE OF STATE .: t+YORKER.'S
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NAIBE LICENSE CONTRACTOR 6 : COMP:NAM6.
UCENSE NUTANR ON RLE
NUMBER 4•.
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