0008-387 (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
r i'oiessioriNs Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
556236 8 / 8/2
Date 10 Signature of Contractor t �!
g l !!�
V,
OWNER -BUILDER DECLARATION V
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 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 STATE FUNT) Policy No. 1576269
(This section need not be completed ift(;ie permit valuation is for $100.00 or less).
( ) I certify that in the performance Y 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 CalifOITf- '`and agree that if I should -become
subject to the workers' compensation provisi ns of Section 3,700 o tth4 Labor
Code, I shall forthwith comply with diose prowQdons.J I
Date: � • U Applicant 1 % p
Warning: ailure to secure Workers'.Co`rrga sation 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 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.
1i A G
t�Signature (Owner/Agent i"r 1; �/ Date �bJ00
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OOW.38? TRACT
t'+t L C, U �1 ,4iit3A0 ;,
JOB SITE t
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
VIC',li�R & 1WABENEZRA
S'OIJRIS.E POOLS
PALM I3MIZT CA 92255
(760)340-5521 CRI # 1604
USE OF PERMIT
POOL At, MOR. SPA
POCIL & SPA ONLY-ALARMSIFJ.AJ RIERS SHALL BE IN PLACK AT PRF
PLASTI?R. iNSPECTIORPOOL EQUiPME.NT ENOi,OSURF ISNOT .IN%.UR)ED
1`N THIS PERMIT
POOLANDIOR SPA 13000.00 LS
FST n"= f'(%ST OF CONUR TCI70M
13,400,00
VERMV IJ";6`EM!.9 T4VIlVMY
PLAN CHECK IU ' �' 101.000.439.318 $99.45
CONSTRUCTION FEE 101_00(1418_000 $153.60
MEC;i1MICAL FIDE -- POOL 101-000-421-000 $24.00
ELECTRICAL 1 VY, •- POOL 101-000-420-000 $45.00
"PLIUMBP.40FRE -- POOL 101.000.419.0100 f2'i.AO
,t
SU13-��oxax, cY01�:r.4�r rCz01s AN PLccr.�
$348.45
LE.9S PRE- FM
$0.00
TOTAL PEYCKI ' FLTS DUE NOW
$340,45
RECEIPT
DATE t
BY
DATE FINALED
INSPECTOR
C) � f�
I4{ i .
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
?�
Set Backs
Electric Bond
�,..
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
00
Underground Plbg. Test
.l
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
(y
ZCv
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:
CITY OF LA QUINTA
cEno� BUILDING & SAFETY DEPARTMENT
OFT 777-7012
INSPECTION REQUEST LINE
777-7153
VICTOR & TINA BENEZRA
Owner
Contractor SUNRISE POOLS
Permit Number 000,9=1,97
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 45-040 COLDBROOK LANE
POOL & SPA ONLY-ALARMS/HARRIERS SHALL BE
IN PLACE AT PRE PLASTER INSPECTION.POOL
EQUIPMENT ENCLOSURE IS NOT INCLUDED IN THIS
DERMIT
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC Q '-1_3.-
ROUGH
I JROUGH PLUMBING
ROUGH GAS & GAS TEST _0-,z
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
\ INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR A KEI-W-E-C-TION F $ '
EXTERIOR LATH WILLB C INEA.ni
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK -
"A Lkj I full
I 1 2 (giJ1111►
ELECTRICAL
PLUMBING
FINAL GAS TEST
H EATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
C