0004-121 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under -penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. ClassExp., Date
I-QL
r692059 C-53 07/31/2(
Z r- Date Signature of Contractor
(fl 0
Ji.— C) OWNER -BUILDER DECLARATION VM
W W r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
U)
Z_ ( ) 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).
co () I am exempt under Section B&P.C. for this reason
U
N Date Signature of Owner
ON
Q)
EL
z
WORKER'S COMPENSATION DECLARATION
2-Z
I hereby affirm under penalty of perjury One of the following declarations:
- F2 O O 1 have and will maintain a certificate of consent to self -insure for workers'
'• X w LL compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q C)(�)�1-have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
111 permit
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
00 5 Cartier 1iRPMONI' COMP INS Policy No. W1I9930347801
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J
(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: x j ..Applicant- ---
Warning: FailIA"ufe 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 isnot 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)-j - - _Date i—
I
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 000.4-121. TRACT
04/12/20C $32,(40(3.00
,JOB SITE
APN
ADDRESS
53-180 DEL GATO DRIVE
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DOV EfkT UMEYERh3AMD
CAHEMJ_.A POOL CONSTRUCTION, WC.
53-180 DEL GX 0 DRIVE
78-7101_APAI1 ADR,, LA QT -WA
LA QUIN TA CA 9225:3
PALM DF.RERT CA 92261,
(760)360-6602 CBIS y 18444' ' t
USE OF PERMIT
POOL AND/OR SPA
FOOL & SPA ONLY - JAd ARMS/SAR=?RS SHALL BL IN PLACE AT
PR&PLASTER INSPECTION
ice?
POOL AND/OR SPA 3"000.00 L�
COST OF CO1�S'TR'UCT1ON
321000.00
-f����jy� y. �l Q pESTI:MATED
A:.�.d4�'8.r FEE h7�h%UR 8
PLAN CHECK IEE 101-000.439-318 $193.38
CONSTRUCTION FEE 101-000418-000 $297.50
MECHANICAL FE9- POOL 101-000.421-000 $24,00
LLWTIUCIAL FEE -• POOL 101-•000-420-000 $45.00
PLUMBING FLEE -- POOL 101.000.419.000 $27,00
3U.B-T0TWT_ C010TtRUCTION AND PIAN 'LWCK
$586,88
LESS PRE -PAI) FEES
$0.00
TOTAL &'FMW FSS DOE NOW
h
RECEIPT
DATE I .
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
12
Footings
Main Drain
/
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
It/
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Ira d itio n
ARCHITECTURAL DESIGN REVIEW
April 6, 2000
Mr. Greg Butler ,
Building and Safety
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Lot 66, Phase 28867, 53=1_$_ 0 Del -Cato Drive
Swimming Pool Review
Dear Greg,
Ci
VTq
AP,q 10 RE .
VG
e SgPEFTY
Via Facsimile
760-777-7011
This letter. will serve as ADRC approval for the swimming pool at the above referenced
residence (copy of approved pool is attached). If you have any questions, please do not
hesitate to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd
pc: Brian Luddington (via first class mail)
it-• `� _� �'. •+ � � 4 ....,.:' , • �• _ -. l .. .i. +
CNdY DowmmIMDRC%D ¢NMMeyv.Pod.npd
78505 OLD AVENuE 52 — LA QuiNTA — CA 92253-1120 --' PHONE 760/564-3355 -- FAx 760/564-2156
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