0204-001 (RPL)U)
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LICENSED CONTRACTOR DECLARATION
I 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 Licepse is in full force and effect.
License # Q s:' Lic. Class Exp. Date
J656128 C53 MC'C-8 ? UP311a?f
Date Signature of Contractor
1
1 0 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/
( )r f 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.
<(- J_ 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 STATE COMC]?MA'1'1 Policy No. mtr$66168-03
(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:
pplicant 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 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 r
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purpose
Signature (Owner/Agent) '-' , (I 41
Signature Dater
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 020,ik-. J TRACT
JOB SITE it
APN
ADDRESS 52.90;'5 CLA# ICT COVE
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Mu HiaZin
CAIMO7:tNLkPOOLS & SPAS (MP lA'3 CO
S2-965 CIARET COQ
'74'72=5 J50141 DRM, ;ii, M.S. #A-
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LA QLMTf'A CA 92253
RAIN DMIRT CA 92260
(760)340-9000 CIVOLO 00355
USE OF PERMIT
MMCILLANBOUS
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VALURIJOA Ls
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PIM CHECK TEE !01-0004,39.3]s $16,23
COINS!'l UC'1'iC.1:Ea!Fitt 101-00"18-000 45,00
STROAif.1MOTION "M - MID 101 -WO -241-000 `..11.50
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RECEIPT
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DAT FIN QLE� INSPECTOR
G
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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 9eck
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
��mp. 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:
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CITY OF LA QUINTA.
13UILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE Ll'Illn- ;tv f%(2- 4-0
REVIEWED By M L
FOR CODE
PIANS AND
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UPON THESE PMY
APPROVAL
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ALL fzEBAR ' TO EE #4
VERTICAL BARS 0 APPROX, 11" O.CC
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8 THICK
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CONC. WALLS
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UTILITY VAULT
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CALIFORNIA POOLS
OF THE
COACHELLA VALLEY
74725 JONI DR. #A
PALM DESERT, CA 92260
kQ'UIPMENT VAULT
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CALIFORNIA POOLS
OF THE
COACHELLA VALLEY
74725 JONI DR. #A
PALM DESERT, CA 92260
kQ'UIPMENT VAULT
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CITY OF LA QUINTA ,
PLAN CHECK CORRECTION LIST
CITY OF LA OUINTA
APR
5 RECD
BUILDING AND BAFB
>y
April 4, 2002
Jeffrey Young
47-159 Young Ln
Indio, CA 92201
PLAN CHECK NO.: 0204-001 (Structural only) FINAL CHECK
JOB ADDRESS: 52-965 Claret Cove OCCUPANCY: U-1
SCOPE OF WORK: New utility vault TYPE -OF -CONST.: V -N
66"x96" vault & CV sewer
The submitted plans and specifications have been reviewed by VANDORPE CHou ASSOCIATES. It is
our professional opinion that the plans are in substantial conformance with the building codes and
regulations adopted by the CITY OF LA QUINTAand the State of California Amendment.
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO OBTAINING
APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND
ASSOCIATIONS.
Plans checked by: �
-Hue C. Luu
VANDORPE CHOu ASSOCIATES.
295 N Rampart Street, Suite A
Orange CA 92868
(714) 978-9780 Ext. 114 VCA File No. LQ -13895
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