0206-094 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under.'provisiops of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class �,� Exp. Date
7210*05 C-53111C04/30/zt
Date 6 r Signature of Contractpr_
OWNER -BUILDER DECLARATION !^
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 EXE&t' T Policy No.
(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 woPkers' compensaiionprovisjons I 9ction 3700 of the Labor
Code, I ha I�for{ with comply with those p visi • nS.
Da` �.A- APPlicaY.sd�..
Warning: Failure to securee'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 i
work is not commenced within 180 days from date of issuance of suc
permit, or cessation of work for 180 days will subject permit to cancellatio .
I certify that I have read this application and state that the above information i
correct. I agree to comply with all City, and State laws. relating to the buildin
construction, and hereby authorddd epresentafives.of this City to enter up
o ;
the above-mentioned propertyyfor ipp�ectio, purposes. _
Signature (Owner/Ag t/t!�-��--•� D to
i
y.•
BUILDING PERMIT PERMIT0#2b6_W4 t
,.
DATE �' VALUATION LOT TRACT
JOB SITE
ADDRESS ei��R4� C9iid=1~
�. ,
APN _ ..
OWNER
CONTRACTOR / DESIGNER / EN (NEER
AF" MACRU
VAlIEff POOL &.%>A
43-589]0, ALMA (X)UKq
A741 C K PALIA ! ANYON DPL #116
I.A QTMITA CA . 02253
PALM: SAIiJ. GS CSA. 92264
Ci6g)778.3939 CBLU 2565
USE OF PERMIT
POOLA`4VOR SPA
,POOL, AN>wd SPA ONLY. ALAMSIBARRIE S SWUL L EL 114 PLACE ?RJOR
O PREPLA— STE:R IAiSPEC'I'.1014, POOL I QUIPMLf'XT Ft`•XCLOSME WOT
INCLUDED 114 PERMIT.
LJ
.j3.
POOLA.►NO/OR SPA '; 2k0a0.0 xZ
EMMUM l:la cosi OF COO "10,2 8
.1101M0.00
Pla.)R18Lffir YEE 90Niilli"'M
FLM CHECK FU 101-000.439.316 $1:4.0
C014STRUCTIOW .'FEF 101-000-4.18.000 $307.0
ME,f:HANIC.xlI,FEE -- POOL 101-M-421-000 $24,00
9L.ZCTRJC Ala c , POOL 101-000-420-000 $45.00
ta:LY71t+1BING .E POOl, 101-000.419-000 827,011
fRYD- TOTAL (2'1013 CT.1:-' .91AND PLAY CI'Il-.CK
$437.!j a
LESS RPA ' X73
$0.00
TMAA.L:�r'e1Vdx"!' DUE NOW
S 4 3 7 _96.
.liisd i3 tlii;L
i
CITY OF LAQUINTA
FINANCEDEPT w
RECEIPT
DATE /_ ;
BAY
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
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
dZ,
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.- ervice
Sub Panels
ExteridN Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
VALLEY POOL & SPA
DESIGN A CONSTRuCTION
4741C E. Palm Canyon, Ste 116
Palm Springs, Ca. 92264
,,,..CITY. OFA LA QUANTA
4741 C PALM CANYON,
f: PALM SPRINGS
CONTRACTOR VALLEY`POOL,& SPA ADDRESS
OWIIKER MACRO "
JOB ADDRESS 43589 PALMA CT
It is the responsibility of .the V,General .Contriict6r,,or the `Owriei/builder ;to monitor the sub -contractors that
are on this list are the sane"persons,pdrforming the work. Any changes to this list must be approved the
City of La Quinta Department of Building) &~Safety to work being. performed by a changed sub-
contractor. Failure to comply will resulf.in a `stoppage'of work and/or the Voidance of building permit.
U8= .O.NTRACTOR
$ C S..
TYPE AF >< :: °
11TE':>:>>>'>:«;;<:»:;
.S7 .;: <;INORKER:.S.;....
<; _ .:..: .
BUSINESS;
TRADE
NAME.;
LICENSE::.....
CONTRACTOR'S
COMP NAME/
LtCENBE:.:'
NUMBER..O;N F1 ::.
'NUMBERI::z
:.::.
EXP DATE".:<:<:
GRADE!
GATTUSO POOL
A/C -12
67,2850
-Z �
816A
EXCAVATE
6/30/ 6.
1%1/03
ot12/03
PIPELINES
C-34
7 G - 02
CONCRETE)
N/A
C-8
FOUNDATIONS
ASPHALT
A
FRAMING
B
STEEL/
C-51:
:STRUCTURAL
MASONRY
CG29
PLUMBING
GATTUSO POOL
C-36
672850
816A
LATHING
C-26.
'DRYWALL
C-9
/yup
PLASTERING
CROWN POOL PLASTERING
C-36
427606-
/30/0 2
3184
HVAC
C-20
#051028!0
g a8 0 L
ELECTRICAL
(General)
GATTUSO°PO,OL
C-10
6 7 2 8 5 0
816A
ROOFING
C-39
SHEET METAL.
i
C-43'=:
FLOORING
C-15
GLASS/
C-17
GLAZING
INSULATION
C-2
SEWAGE DISP.
C-42
PAINTING/
C-33
DECORATING'
TILE
C-54
CABINETS/
C-6
INSTALLATION
FENCING
C-13
LANDSCAPING .
C-27
POOLS
C-53
OTHER
r
721,87--.-/'�REM@P�ff-tNS'CO
9/19/02
4 A
/ /03
J . & L.
AT[41U.D A�.� 30 YT13
M.72i.S...af' -
AOYMA,) WjA9 :) f €%' �
2G,✓�Ag2 MJAq R
�22 iQ�A Ar -2 u JOOq Y9!JAV 1.1OTOAAT000
•;�,!?�li-.3<stliil��.�� 1it�4�.�1.4_%?I�#�.4.�.�fls�!��-�L.ill�.�l.t��l.>fat'�i�',St.�2D.2�19_'7.�i..�if.�.lD.L:L��il�Y
IsHt v IOYOf,i.nOo-dua sr11 tOTjrIO ri 01 -lubliuMienwO 9rif io irtosi,nuO lverior7 uric- lu yiclidienocl ei erlt ai it
tori? bdvo,gge sed teu,m Sail r.Mi or eognedo yr1A .Aiow aril onirmoitsc; eno4lsq smse Or13 Sts foil amt no s.s
due baens to c Cid bormobaq nniod �liow o3 fir;; ylois2 A nnibliu8 }o sremne-g9.3 siniui) r,J io y1il
.1imiaq gnibliud is csobsbiov crit iolbris ftw 3o ograggoSa o ni sluafii Iliw ylgrnov oY siultc;q ioj3wlnoo
i
L,:3141WH
! i- 3TAM
3203311
�R3EIrAUZ
3TAO AX5
cP.'P1:1)IRMNr
1310Al" .41VI00 e'ROTOAI:<•€'IM)
31i -i ISD Fi38MUW - 3; 1r1.331J
sGa rY,uvl
y0 39Y
]8%i33u
( WAAL,
3QAFIT
_
-+ A
rorlaaC� T..
r 0
£fAt.f `•G•.\)
s r ��ei
o�`l OZU TT A,
3TAVA, 3 f
s-�
A
A\I4 ..._.
�:-€•r�l���aa �
2HGITAr1L UDI '
r
TJAHgBA
r
r a-3
:333T2
(2!Z
JARUTOLInTP.
YFIVICACA"M, i
-----.
Air1
-
1 0-�F3SCi3
3E3 ��
JOG'S C) !)TTA
31418RfsLjJg1
.
3.�-3
4 Jlrilh'7A.1
B 7
Os
awu r2AA9 !009 VIV;')3J
IJAWYAa
1 IDWISMIUq
OAVH
t
Aa i 8
4Zf3S`a
0r'3
1
f77h Ult1TTA@
£A 3
JAT31M T. Mtia f
i
S-3
MOITAJUPY1t
PI
j
-0
ID1R1'r•vliA9
..�r'I•fANo��a
..__.....lt.__._._..
b 3 �3
8-0
3AT i
WO T AJIATMil i
if_..
t
P$�
GJ ZMI T14C�:43A t
"`til ..
°►�.�^.t� a .. _ _ ._%1]:L�rti
\ _•
J Kg L
._.