6160 (RPL)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
Profess^e�fals'ode, and my License is in full force and effect.
License # Lic. Class Exp. Date
389 7 C -Sze. f�jj 3/3!!98
" D,afe�n �;l -� Signature of Contractor u A - SAM id L� tF
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 & Profcssionals Code).
as owner of the property, am exclusively contracting with licensed
contractors to, construct the project (Sec. 7044, Business & Professionals
3Code).
( ) 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.
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 Policy No.
GOLDEN EAGLE WC381a61132
(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: 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 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
th2Eove-mentioned property for inspection purposes. f
Signature (Owner/Agent)1� AA-xt/ Date «/ 1
BUILDINGPERMIT PERMITN CONCTROLq}/��
DATE VALUATION LOT X3710-'158 TRACT V 1 L 0
$13.000.00
JOB SITE
APN
ADDRESS
53-"� 5 AVENIDA t�AVAItRO
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LEE TAYLOR
MASTEPL POOLS
53-955" NIDA NAVARRO
'73-555 HIGHWAY 111
LA 1yiC r9rA CA 97253
PALM DESER I' CA 922250
til'. j346. 115 CBLh 16
USE OF PERMIT '
if .
pool. oldy
A
P(X.)L AND)OR SPA. 13,{.00 LS
t!,�"ftR XfEOD COST OF CONSTRI "i'ION
93,tf1)it.tiit
PERMIT PEE SUMMARY
PLAN CHECK ME 101.-000-439-318 $93.0
CONSTRUCTION F'EF, 101-000-118-000 $144:00
MCCHANICAL FEE -- POOL 101.-000-1121.000 $24.00
F.LECTRWA,LFEE --POOL 101-000420-000 18.00
PL,UNIBING FRE -- POOL ,101-000-41.9.1100 $27.00
Sf 113-TCrA'L r.'O-NSfFUCTION .AJgL1 PLAN CHECK
$333.00
�r LESS PRE -PAID FEES
1i00)
TOTAL PE NUT EiEES UEFE NOW
$333.60
OCT 2 7 1997
'RECEIPT(`rr
:twt .l: C.r.O-
DATE
BY'
DATE FINALED
INSPECTOR
%a
rte
W
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
S# Backs
Underground Ducts
Farms & 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
_
Footings
Main Drain
_
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground PI . 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
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)