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LICENSED CONTRACTOR DECLARATION
I heresy 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
P=fessimils Code, and my License is in full force and effect.
License '# - Lic: Class. Exp. Date
536236 C4 , 61;�Z(
11
Date Z}.�(j Signature of Contractor [
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I` m 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 which this permit is issued.
(&A'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 STATE F"D Policy No. 0762d.0
(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 shoold become
subject to the workers' comp`nsE 'in�„rovisions of Section 3700 of the Labor
Code, (,shall fort with comply with those provisions.r
Date:" " Z. j Applicant li ��✓�
Warning: Failure to secure Workers' Co p nsation cove age is unlawful and
shall subject an employer to criminal pdrialties 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 City, and State laws relating to the'building
construction, and hereby, authorize representatives ofj this City to enter upon
the above-mentioned property for, inspection ptarposes, r?
Signature (Owner/Agent)
Ly BUILDING PERMIT PERMIT#
DATE VALUATION LOT OCM,307 TRACT
53.6,2U�T.ffU
JOB SITE
APN '
ADDRESS 4".". iyO1<.D.1 ROOK
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CARL & 1• (LGA PAIM,
SURRISE POOLS
45-395 COLDBROOK
44028 B1,71MORN TR.
1.k QUWrA CA 92253
PALM 13EMT CA 92255
(760)340-5521 C1; W 1604
USE OF PERMIT
POOL ANDIOR SPA
POOL. &SPA ONLY-ALARUMARMERS SHAIJ, WE tN PLACE, AT PRE
PLASTER MSPEC: I.ONYOOL RQUIPTr1tN':�fT ENCLOISPUT RIS NOT INCLUDED
IN THIS 1'LTiiMIT
POOLANIDIOR SP.A. d6, 06.W 1B
XMMATED C09r OF CO1NS"iIRUCITOR
16,200.00
RAMUTE aiVASRY
PLAN CHECK FE 101.000.439.3169 $117.00
CONS RUCTIOW PEE 101-000-418-000 $190.00
A4PC1:1AN1CAL FEE -- POOL 101.000.421-000 $24.00
ELECTRICAL FEE - POOL 101-000-420-000 $45.00
PLI) INNO F'FP. -- POOL 101.000.4'19.000 $27,00
'y
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3-OB-TMALCC}NMUC110M AND PLAN CHECY
$393.00
;. LRDS M PAID(
$0.00
T01VM ITRM r TX1i'S DV 1 f0W
101
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[RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
F
INSPECTION RECORD
1. OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
16
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Sacks
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final V
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Final
Underground Electric
Underground Plbg. Test
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
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)
Final
COMMENTS:
"
P/L--'A
all
ry
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
OOL EQUIPMENT
GENERAL SPECIRWONS
int Ct7p 1 5 — 3 O
Myh_Cei&9:U6I6Ia
p RE -INSPECTION FES Of $30
APPROVE ACCESS
1Nll l BE CHARGED IF TH DECKING
/L
PANS AND lD6 CARDSCHEDU ED "
THE SITE FORA
1NSPECT�O �CEpnOrj$: SPA SPECIFICATIONS
SIZE -7 '
(760) 340.5521
PALM DESERT, CA
SHAPE C U S T O M
JETS �t
RAISED
BENCHES
BOOSTER
}
CApL AN I2 I-II L G A p P l
L- or 33
LA Q UIN-rA, CA
APPROVED BY:
THIS DRAIMNG REMAINS THE PROPERTY OF SUNRISE
POOLS. REPRODUCTION OR UNAUTHORIZED USE
1MTHOUT PERMISSION IS PROHIBITED.
F