0002-173 (RPL)Cy
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LICENSED CONTRACTOR DECLARATION
,ie __'3 ffirm under pens y of'pedury 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
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/Date. I C fln Signature of Contractor -
OWNER -BUILDER DECATI N
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 whichthis permit is issued.
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:
Cartier Policy No.11
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(This section need not be completed'•If the permit valuation is for $100.60.or less).
O I certify that in the performance of the work for which this permit is,issued,
1 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' compensatio provisions of Section 3700 of t Labor
,Code, I s all fo wtth comply With t os pr visions.
Date: -��pplisan -
Warning: Failure to secure WorkersCompnsation coVerage'is unlawful and
shall subject an employer to criminal enalties and civil fines up to $100,000, in
addition to the costof 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 resultof this applicator 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 aut nze representatives of this City to enter upon
the above-mentioned property.jor iljgpQction purposes. l
Signature (Owner/Agent)
BUILDING PERMIT PERMIT#
DATE VALUATION G�9�11(3189� LOT TRACT
JOB SITE 5170
APN
ADDRESS 52r4% DEL C O ORP d.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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PALM 101ispXT C -A 92261.
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USE OF PERMIT
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RECEIPT
DATE
BY4 r
DATE FINALED
INSPECTOR
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:
IBLOG4ZWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings -
Main Drain
Bond. Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test VIP
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice.(Gas)
ELECMCAL 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:
' r ' 'on
� its
ARCHITECTURAL DESIGN REVIEW
February 3, 2000
Revised February 14, 2000
Mr. Greg Butler
Building and Safety
CITY OF LA QUINTA
78-495 .Calle Tampico
La Quinta, CA 92253
Re: Lot 5, Phase, 28470-2, 52-590 Del Gato Drive
Swimming Pool.Review
Dear Greg,
Ca 7f.
FFB 2
2 RECp
BViL®1yVG` Hilt,, .
Via Facsimile
760-777-7011
This letter will serve as ADRC approval for the, above referenced swimming pool (plan
attached). If you have any questions, please do not hesitate to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd.
pct Bob McKay, (hand delivery)
cvaoow-AN=WnmP*&-0
78505 OLD Ave4u 52 L4,QuwrA -- CA 92253-1120 - PHONE 760/564-3355 --- FAx 760/564-jW6